Chapter 3 - Review of Related Literature

H.I.V.E.
Homecare Sanctuary
San Isidro Cararayan, Naga City
CHAPTER III
Review of Related Literature
I.
The Homecare Facility
A. Introduction
for the suffering soul, world is healing.1
Long term care refers to a comprehensive range of medical,

personal, and social services coordinated to meet the physical, social, and
emotional needs of people who are chronically ill or disabled.2 A facility such
as nursing home is the best choice for people who require 24 hour medical
care and supervision.
The facility offers highest level of care for disabled and older adults
outside of a hospital. Nursing homes provide what is called custodial care,
including getting in and out of bed, and providing assistance with feeding,
bathing, and dressing. However, nursing homes differ from other senior
housing facilities in that they also provide a high level of medical care. A
licensed physician supervises each patients care and a nurse or other
medical professional is almost always on the premises. Skilled nursing care
is available on site, usually 24 hours a day. Other medical professionals,
such as occupational or physical therapists, are also available. This allows
the delivery of medical procedures and therapies on site that would not be
possible in other housing. 3
Although nursing home has negative connotations for many people,
such facilities still provide an important component for disabled and senior
housing options. It's important to separate nursing home myths from facts.4
Menander, from the 10th European Conference on Rehabilitation and Drug Policy-10th-14th
May 2005
2 Emma Nochomovitz n.d. Skilled Nursing Facilities and Other Long Term Facilities
3 http://www.webmd.com/health-insurance/nursing-home-care
4 Ibid
22 | R E V I E W O F R E L A T E D L I T E R A T U R E
H.I.V.E. Homecare Sanctuary

B. Overview
1. Foreign Literature
Modern Clinical Psychiatry, Lawrence C. Kolb, MD, 1977 by

W.B. Saunders Company
The widespread application of the newer therapies continues
to both prevent and reduce the need for long-term institutional care
of the psychotic. But emergent from those success, one of the most
striking in the arena of care of the presumed chronically ill, it has
become apparent that deficiencies in social competency either
continue or recur in many who are returned to community life. The
future goals of psychiatry and other mental health disciplines must
reach beyond the correction of psychopathology, and be clearly
directed toward establishment or restoration of socially competent
behavior in the social setting.
Modern psychiatry is that branch of medicine concerned with
the manifestations and treatments of the disordered functioning of
personality which affects the individuals subjective life, his or her
relations with others, or the capacity to adapt in life society.
Psychiatry is directed to the origins and the dynamic interactions of
the personality as they contribute to the development of mental
disease. Origins include the genetic determinants, whether of
chromosomal derivation or resulting from prenatal factors, family and
social transactions, and experiential deprivations which often
underlie the specific selection of forms and behavior.
Psychiatric Nursing, Marguerita Lucy Manfreda, R.N. M.A., 1964

by F.A. Davis Company
The seventh edition of psychiatric nursing contains ten new
chapter as well as revisions made in several other area of the text. A
considerable portion of the new manuscript is devoted to discussion

of the various concepts associated with mental illness, human

behavior, and nursing care.
Time-Saver Standards for Building Types Second Edition (pp.

482-488), Joseph de Chiara and John Hancok Callender, 1983
by McGraw-Hill Book Co. Singapore.
TIME-SAVER STANDARDS FOR BUILDING TYPES is a
natural outgrowth of the present fourth edition of Time-Saver
Standards, A Handbook of Architectural Design Data. Over the
years, as Time-Saver Standards became more popular and
comprehensive, it also became larger in size and more cumbersome
to use. In addition to containing architectural design data, the fourth
edition also had some design material dealing with specific types of
buildings. When the book was ready for a fifth revision, it became
apparent that changes had to be made in the content and format of
the book. In order to be able to include new design data in a
comprehensive manner, it was decided to remove the material
dealing with building types from the fifth edition and use this material
as a core for the new book: Time-Saver Standards for Building
Types. The original material has been revised, greatly expanded,
and reorganized to cover all of the major building types. The result
has been a completely new handbook for the architectural
profession. It evolved from and follows the tradition of the first four
editions of Time-Saver Standards.
Time-Saver Standards for Building Types and Time-Saver
Standards for Architectural Design Data, 5th edition, are closely
related but, in fact, are separate and independent books. Time-Saver
Standards for Building Types is intended primarily to meet the needs
of those who are involved in the conceiving, planning, programming,
or design of buildings. It is intended to give basic design criteria for
each major type of building. It will give those unfamiliar with a specific
type of building a talking or working knowledge of its functions,
organization, and major components

Psychiatric Services and Architecture, A. Baker, R. Llewelyn

Davies, P. Sivadon, 1999 Switzerland
A WHO Expert Committee on Mental Health in 1952 set out
the principles which should govern the structure and function of
psychiatric hospitals. It stressed the value of hospitals pervaded with
a strong therapeutic atmosphere which would be in close liaison with
the surrounding community. The Executive Board discussed this
report in its Twelfth Session, and requested the director-general to
draw to the attention of Member States the desirability of bringing
this report to the attention of all authorities responsible for the
planning and management of mental hospital and to bear in mind the
principles and recommendations contained in the report when
planning future WHO activities in the field.
Psychiatry, James H. Scully, M.D., F.A.P.A., 1985 by Harwal

Publishing Company
This book is designed to outline the major clinical areas of
psychiatry, and the current understanding of the diagnosis and
treatment of psychiatric illness in presented in outline form. While
only a few physicians specialize in the area of mental illness, almost
every physician sees patients with psychiatric disorders in his or her
clinical practice. Many surveys of practice patterns reveal that nearly
one-half of the patient with psychiatric illness receive most, if not all,
of their care from non-psychiatric physicians. It is clearly necessary
then for all physicians to know something about the diagnosis and
treatment of psychiatric illness.
Psychiatric Nursing Biological & Behavioral Concept Second

Edition, Deborah Antai-Otong MS, RN, CNS, PMHNP, CS, FAAN,
2008
The history of psychiatric-mental health nursing is rich and
reflects the evolution of societal, economic, legislative and cultural
influences, and technological advances. Despite their conservative
beginnings as custodians of care, the role of psychiatric-mental
health nurses continues to reflect contemporary socioeconomic and

legislative trends and the explosion of technological advances in

neuroscience and cyberspace. As these technological advances
make an impact on lifestyles and health, cultural factors remain an
integral part of society and influence individual health practices and
response to life span stressors. Today, the psychiatric-mental health
nurse faces the challenge of integrating the intricacies of scientific
studies, societal norms, and cultural factors and their effects on
human behavior into evidence-based interventions.
As psychiatric nursing progresses into the twenty-first century,
efforts to promote its survival in a changing health care system are
paramount. The historical influences of professional organizations,
nurse researchers, and educators continue to affect psychiatricmental health nursing. Nurse educators, nurse researchers, and
professional
nursing
organizations
are
challenged
to
play
quintessential roles in the future of psychiatric nursing. Their roles

are likely to involve integrating psychiatric-mental health nursing
concepts into nursing curricula and developing and offering
innovative clinical and classroom experiences to nursing students.
Older People and Mental Health Nursing: A Handbook of Care,

Rebecca Neno, Barry Aveyard and Hazel Heath, 2007 by
Blackwell Publishing
Mental health in later life is influenced by a complex set of
biological, psychological and social interactions. As such, nurses
need to be aware of how each of these influences may affect the
older person with mental health needs. In addition to these
influences, older people may also have to cope with societal
assumptions that ageing automatically brings mental decline, and
that no treatments are available. Nurses need to be able to challenge
such views and assumptions, and to do this they must have
adequate knowledge relating to the natural ageing process and skills
in communication to be able to get their message across. These are
seen as fundamental principles of mental health care for older adults
and, of course, will be explored further within this book.
The underpinning concepts and approaches in this book value
individual persons within the context of their lives, experiences and

relationships. Mental health is seen as an integral aspect of overall

health and as a continuum between wellness and illness. Traditional
views of mental ill-health as disease can lead to people who
experience this being labelled as different, with all the stigma this
can attract. Rather, as Crump (1998, pp. 172173) argues, we
acknowledge that
we all have both wellness and illness . . . mental health and
mental distress are a continuum on which we all move back and
forth, attempting to strike the right balance . . . People who have
moved along the continuum away from health are still the same
people but are now distressed and in need of support and
understanding. The difference is not merely political correctness: it is
crucial to how we perceive mental health nursing and, more
importantly how we perceive those who find themselves requiring
mental health support.
This book focuses on the knowledge and key skills which
practitioners require or must have, to work effectively with older
people who have, or are at risk of developing, mental health needs.
The text is aimed primarily at nurses working in all settings and all
types of roles, but, acknowledging the intrinsically interdisciplinary
nature of older peoples services, much of the content is relevant to
all disciplines. The content relevant to older peoples mental health
and care is broadly applicable, and the social policy, legislation and
details of specific services are relevant to the UK.
It is intended that this book will enable practitioners to develop
their knowledge and skills through the completion of the practice
examples found within most chapters. These examples are meant to
be thought-provoking, allowing readers to link theoretical concepts
with their practice and ultimately improve the delivery of care.
Guidelines for Nursing Homes Ergonomics for the Prevention

of Musculoskeletal Disorders, Elaine L. Chao, Secretary & John
L. Henshaw Occupational Safety and Health Administration,
Assistant Secretary, 2009

These guidelines provide recommendations for nursing home

employers to help reduce the number and severity of work-related
musculoskeletal disorders (MSDs) in their facilities. MSDs include
conditions such as low back pain, sciatica, rotator cuff injuries,
epicondylitis, and carpal tunnel syndrome. The recommendations in
these guidelines are based on a review of existing practices and
programs, State OSHA programs, as well as available scientific
information, and reflect comments received from representatives of
trade and professional associations, labor organizations, the medical
community, individual firms, and other interested parties. OSHA
thanks the many organizations and individuals involved for their
thoughtful comments, suggestions, and assistance.
More remains to be learned about the relationship between
workplace activities and the development of MSDs. However, OSHA
believes that the experiences of many nursing homes provide a basis
for taking action to better protect workers. As the understanding of
these injuries develops and information and technology improve, the
recommendations made in this document may be modified.
Although these guidelines are designed specifically for
nursing homes, OSHA hopes that employers with similar work
environments, such as assisted living centers, homes for the
disabled, homes for the aged, and hospitals will also find this
information useful.
OSHA also recognizes that small employers, in particular,
may not have the need for as comprehensive a program as would
result from implementation of every action and strategy described in
these guidelines. Additionally, OSHA realizes that many small
employers may need assistance in implementing an appropriate
ergonomics program. That is why we emphasize the availability of
the free OSHA consultation service for smaller employers. The
consultation service is independent of OSHAs enforcement activity
and will be making special efforts to provide help to the nursing home
industry.
These guidelines are advisory in nature and informational in
content. They are not a new standard or regulation and do not create
any new OSHA duties. Under the OSH Act, the extent of an

employers obligation to address ergonomic hazards is governed by

the general duty clause, 29 U.S.C. 654(a)(1).
2010 State Regulatory Trends and Evidence to Inform American

Institute of Architects (AIA) Nursing Home Design and
Construction Guidelines, Lois J. Cutler, PhD and Rosalie A.
Kane, PhD Division of Health Policy and Management School of
Public Health University of Minnesota
This report is the result of the first phase of research activity
that aims to inform the development of the 2010 Guidelines for
Design and construction of Health Care Facilities, Section 4.1
Nursing Facilities. This report summarizes variation in federal and
state regulations pertaining to building structure and design of
nursing homes; compares the language and the substance of these
regulations to the existing Guidelines; and reviews these findings in
the light of evidence for various design elements and the trends in
nursing home care in the 21st Century. In the second phase of the
project, we will engage a peer group in examination of the
recommendations and will produce a document that distills the
commentary and further discusses the pros and cons of each
recommendation.
The traditional medical model nursing home is changing at a
rapid pace changing its organization patterns, changing its physical
environment, and changing it philosophy of care. Stimulated by
state-level culture change coalitions and directives from the Centers
for Medicare and Medicaid Services that the Quality Improvement
Agencies include encouragement of culture change in their scope of
work, many nursing homes and state officials are eager to be part of
the culture change movement, although such identification has no
clear cut roles, design or expectations just a rapid expectation of a
different type of nursing homes. Along with changes in organization
(for example, moving towards universal workers, permanent
assignment, expanded and blended roles for various personnel,
decentralized team management) and changes in philosophy
towards individualized services, resident-centered and residentdirected care, and creation of normalized caring communities of

residents and direct staff comes an expectation that the physical

environment will support such changes. The household model is in
long corridors are out. Double-occupancy rooms, particularly those
with side-by-side beds whose placement are dictated by hospital-like
wall installations have been widely recognized as un-conducive to
quality of life or optimal functioning. Fortress-like nurses stations
with offices behind that permit staff to retreat behind high visual
barriers are being replaced by new approaches. Designs and
materials throughout the nursing home are, as much as possible,
expected to produce a sense of home.
Psychiatric-Mental Health Nursing An Interpersonal Approach,

Jeffrey S. Jones, DNP, PMHCNS, BC, LNC, Joyce J. Fitzpatrick,
PhD, MBA, RN, FAAN, Vickie L. Rogers, DNP, RN, Springer
Publishing Company
This Student Guide is designed to further develop your
understanding and application of psychiatric-mental health nursing
concepts. Key Terms, Expected Learning Outcomes, and Need to
Know points are reviewed. Further cases are presented to gain more
practice of care planning skills. Additionally, there are exciting and
enlightening hyperlinks to films that illustrate the main point or theme
of each chapter. Overall this material will supplement what you are
learning in class, challenge and stimulate your thinking, and
hopefully prompt lively discussion among you and your peers around
this important area of nursing practice.
Care of the Psychiatric Patient in the Nursing Home: Challenges

and Opportunities, Jacobo E. Mintzer, MD, June 2002,
Nursing home residents with psychiatric disorders deserve to
enjoy the full spectrum of therapeutic options that are available to
their counterparts living in the community. These therapeutic options,
the tools of the geriatric psychiatrist, include a broad range of
traditional and novel psychotropic medications, in addition to wellrecognized no pharmacologic interventions such as psychotherapy.

In this issue of Long-term Care Forum, Gary Kennedy, MD, of

Albert Einstein College of Medicine, describes how the inappropriate
use of psychiatrys therapeutic tools in nursing homes during the late
1980s ultimately prompted government interventions, engendering a
strict regulatory climate that persists today. William Reichman, MD,
Past- President of the Geriatric Mental Health Foundation and PastPresident of the American Association for Geriatric Psychiatry
(AAGP), provides an overview of the impact of poor psychiatric care
on the nursing home milieu. He emphasizes the need for an
increased on-site presence of geriatric psychiatrists, together with a
therapeutic strategy that recognizes and values the contributions of
a devoted and well-trained nursing staff.
Finally, from a different perspective, Lori Daiello, PharmD,
BCPP, member of the American Society of Consultant Pharmacists
Board of Directors, examines the various clinical consequences
that may arise from the use of psychopharmacologic tools. She
details the types of clinical problems that can occur whenever
psychoactive medications are used, even in an appropriate manner,
in the high-risk nursing home population.
Nursing Home Standards, Department of Health, Social Service,

And Public Safety U.K., January 2008,
This document sets out minimum standards for Nursing
Homes. The standards specify the arrangements, facilities and
procedures that need to be in place and implemented to ensure the
delivery of a quality service.
The Order allows for the establishment of the Northern Ireland
Health and Personal Social Services Regulation and Quality
Improvement Authority (the Regulation and Quality Improvement
Authority), an independent body with responsibility for, and powers
to, regulate establishments and agencies in the Health and Social
Care (HSC) and the independent sector. Responsibility for all
services previously regulated by the Registration and Inspection
Units of the Health and Social Services Boards is transferred to the
Regulation and Quality Improvement Authority.

Article 38 of the Order confers powers on the DHSSPS to

prepare, publish and review statements of minimum standards
applicable to all services including regulated services. The
Department has developed minimum standards for a range of
regulated services including nursing homes. These standards were
developed with the help of patients, their representatives, staff,
professionals, inspectors, commissioners and providers. The
standards were also subject to a full public consultation process
between September and December 2004.
The standard statements and associated criteria cover key
areas of service provision, are applicable across various settings,
and are designed to be measurable through self-assessment and
inspection. The Regulation and Quality Improvement Authority will
look for evidence that the standards are being met through: - Discussions with patients, staff, managers and others
- Observation of activities in the home
- Inspection of written policies, procedures and records.
Code of Practice for Residential Care Homes for Persons with

Disability, Social Welfare Department, 2002
This Code of Practice is issued by the Director of Social
Welfare, setting out principles, procedures, guidelines and standards
for the operation, keeping, management or other control of
residential care homes for persons with disabilities. A residential
care home for persons with disabilities (RCHD) means any premises
at which more than 8 persons with disabilities over the age of 15 are
habitually received for the purpose of care while resident therein.
This Code of Practice sets out the minimum standards and
guidelines for hygiene, fire, building safety, and the level of care
required, which aims at ensuring that residents in these homes
receive services of acceptable standards that are of benefit to them
physically, emotionally and socially.

Rehabilitation Centre Architectural Spaces and the eformation

of Drug Addicts, Ermina Stephanidou, 2011
Many specialists of various fields, including sociologists,
therapists and architects have repeatedly argued about how place
and the design of its spaces communicate with the human psyche,
affect the way in which people react to their lives and how they
develop. And this might be said to be rather crucial for any individual
who requires long term constant care or needs to recover from a
period of physical, social and emotional instability such as the multifaceted break down and loss of self-brought about by drug addiction.
It is important to note from the outset that architecture is not a
treatment, but can most significantly become part of the healing
process through the creation of spaces that foster and provide
meaning to those activities utilized to achieve gradual rehabilitation
through a therapeutic environment. Light, colour and movement
within a residence as well as landscape and location are essential
elements of this architectural therapy and the paper will seek to bring
their relevance to the fore in the 2nd part of this paper.
It is a setting which readies for social inclusion and does not
bunch up people as a group of patients who simply need to take their
medication or stay indoors for a prolonged period of time but as
active recipients of change and individuality. Not merely a number
behind a health facility door. Architectural design can provide the
corner stone of this individuality, with spaces built as an interactive
process as opposed to holding a disorder within. As Cynthia
Leibrock puts it, even the little things in the design of a building can
play their part in the psychology of the healing equation; such as the
way windows reflect the sunlight in a therapeutic community
residence.
From Almshouses to Nursing Homes and Community Care:

Lessons from Medicaid's History, Sidney D. Watson, March 21,
2012 College of Law Publications at Scholar Works @ Georgia
State University
Home and community-based services are support and longterm care services that offer an alternative to institutional care for

those who need assistance with life's daily activities. For Lois Curtis
of Atlanta, one of the plaintiffs in the Olmstead v. L.C.1who spent
most of her life in mental institutions, it means a live-in companion
who helps her with the day-to-day activities of living in her own home,
like managing finances, cooking meals, and keeping track of
medications. For Larry McAfee, another Georgian who was
quadriplegic, community-based services involved round-the-clock
personal care, wheelchair accessible bathrooms and kitchens, a
specialized computer, and a specially adapted van.
Long-term Mental Health Care for People with Severe Mental

Disorders, Jose Miguel Caldas de Almeida and Helen Killaspy,
European Union, 2011
The provision of long-term mental health care for people with
severe mental disorders has been, and still is, one of the major
challenges for mental health systems reform in the last decades, for
various reasons.
Firstly, although these disorders have a low prevalence, the
impact they have on individuals, families and societies is huge. The
group of schizophrenic disorders are the most important of the
severe mental disorders since they are associated with the greatest
impact on functioning. Schizophrenia has an estimated point
prevalence of 0.4% and a lifetime risk of 1% i.e. one in a hundred
people will suffer from schizophrenia during their lifetime (Goldner et
al., 2002). It is the 7th most important disease in terms of years lived
with disability, accounting for 2.8% of disability caused by all disease.
For people aged 15 to 44 years, it is the 3rd most important disease,
accounting for 4.9% of disability caused by all diseases (WHO,
2008). .
These early initiatives have been followed by a multitude of
further developments throughout Europe that have helped to
advance mental health care in many countries. These include
improvements in the living conditions in psychiatric hospitals, the
development of community services, the integration of mental health
care within primary care, the development of psychosocial care
(housing, vocational training), the protection of the human rights of

people with mental disorders and the increasing participation of

users and families in the improvement of policies and services
(Muijen, 2008). Research into many of these developments has
provided an increasing evidence base to guide investment into
appropriate mental health care systems.
Long-Term Care Home Design Manual, Ministry of Health and

Long-Term Care, Ontario Canada 2009
The Long-Term Care Home Design Manual, 2009 (the Design
Manual) contains the Ministry of Health and Long-Term Cares
revised design standards and retrofit standards for long-term care
homes in Ontario. In using this Design Manual, please keep in mind
that the standards are the minimum design features that must be
achieved for all applicable long-term care home projects.
The Long-Term Care Home Design Manual, 2009 promotes
innovative design in long-term care homes in Ontario. These new
design standards give service providers greater flexibility to create
environments that make it possible to respond positively and
appropriately to the diverse physical, psychological, social and
cultural needs of all long-term care home residents.
The Design Manuals goal is to integrate design concepts that
will:
facilitate the provision of quality resident care in an
environment that is comfortable, aesthetically pleasing and as
home-like as possible.
support well-coordinated, interdisciplinary care for residents
who have diverse care requirements.
Skilled Nursing Facilities and Other Long Term Care Facilities:

Addressing Issues of Cost and Quality, Emma Nochomovitz,
n.d.,
While the evolution of the nursing home and long term care
industry has experienced many improvements, it remains far from
perfect. Increasingly, the United States is devoting higher levels of

spending to healthcare (Care 2008). Healthcare spending particular

to long term care is no exception to the trend of rising cots. In 1985,
the average monthly cost for a nursing home stay was $1508
(Statistics 2006). By 1999, this price had nearly doubled, and the
monthly charge per nursing home resident was $3531. On an annual
basis, data from 2002 rates the cost of a semi private nursing home
room at $52000 (Stone 2006). By 2005, the average national cost of
nursing home care was $7400 (Binstock, Cluff et al. 1996).
After
Substance
Abuse,
Dr.
Howard
Samuels,
2011,
http://www.thehillscenter.com/
The Hills Treatment Center offers a unique educational and
therapeutic drug and alcohol rehabilitation experience in Los
Angeles, CA. The Hills Treatment Center offers a coalition of the
finest minds. Our rehabilitation facility uses the best research
practices an alcohol and drug rehab has to offer, including services
for co-existing disorders, dual diagnosis, and mental health issues
through several psychiatrists whom we are closely affiliated with.
The staff at The Hills understands the need to provide privacy
in a supportive setting. Located on a secluded gated private road The
Hills maintains three separate houses each full staffed 24 hours a
day, seven days a week.
Nursing Homes and Law, Stimmel, Stimmel, & Smith, 2003,

http://stimmel-law.com/article/nursing-homes-and-law,
retrieved June 24, 2014
That stereotype was not really accurate thirty years ago when
such types of facilities were far more prevalent and is usually grossly
inaccurate today. Assisted Living Facilities have blossomed with
excellent and vibrant programs to engage the elderly and afford them
not only excellent medical care but also provide the type of social
interaction that makes the final years of life far more rewarding. As
one client once told the writer, to compare an Assisted Living Facility
of today to the old views of nursing homes is to compare the insane
asylums of 1750 to psychiatric treatment of today.

Stereotypes die hard. However, more and more people,

facing the daunting prospect of maintaining a family home far too
large for themselves, with children and grandchildren often living
hundreds or thousands of miles away, now confront a situation quite
different than the one facing their own parents. One can locate
excellent places to live which will provide adequate medical care for
the rest of your life and which are not the horrible places previously
imagined.
Theories
applied
in
Community
Health
Nursing
http://currentnursing.com/ , Date Retrieved June 26, 2014

The concept of community is defined as "a group of people
who share some important feature of their lives and use some
common agencies and institutions." The concept of health is defined
as "a balanced state of well-being resulting from harmonious
interactions of body, mind, and spirit." The term community health is
defined by meeting the needs of a community by identifying problems
and managing interactions within the community
Nursing Theory, http://www.nursing-theory.org/ , Date retrieved,

July 3, 2014
Psychiatric and Mental Health nursing deals with the care of
patients who have emotional and mental health concerns such as
depression, anxiety, addiction, and mood disorders. Nurses care for
individuals, families, groups, and communities through counseling,
education, and, in some cases, medication to promote mental and
emotional health.
Family
Involvement
Treatment,
is
Important
Steven
in
Gifford,
Substance
LICDC,
Abuse
LPC,
http://psychcentral.com/ date retrieved: July 3, 2014

For family and friends of drug- or alcohol-addicted individuals,
addressing the addiction is one of the most difficult aspects of helping
the addicted person seek treatment. Often, over time, daily family

involvement has only managed to enable the addict. Family

members frequently do not know how to bring up the issue of
addiction therapy, and opt to ignore the problem for fear of pushing
their loved one away during a confrontation or intervention.
2. Local Literature
WHO-AIMS Report on Mental Health System in the Philippines,

World Health Organization, 2007 Manila Philippines,
The World Health Organization Assessment Instrument for
Mental Health Systems (WHO-AIMS) was used to collect information
on the mental health system in the Philippines. The goal of collecting
this information is to improve the mental health system and to provide
a baseline for monitoring the change. This will enable the Philippines
to develop information-based mental health plans with clear baseline
information and targets. It will also be useful to monitor progress in
implementing reform policies, providing community services, and
involving users, families and other stakeholders in mental health
promotion, prevention, care and rehabilitation.
The Philippines have a National Mental Health Policy
(Administrative Order # 8 s.2001) signed by then Secretary of Health
Manuel M. Dayrit. There is no mental health legislation and the laws
that govern the provision of mental health services are contained in
various parts of promulgated laws such as Penal Code, Magna Carta
for Disabled Person, Family Code, and the Dangerous Drug Act, etc.
The country spends about 5% of the total health budget on mental
health and substantial portions of it are spent on the operation and
maintenance of mental hospitals. The new social insurance scheme
covers mental disorders but is limited to acute inpatient care.
Psychotropic medications are available in the mental health facilities.
A Commission on Human Right of the Philippines exists, however,
human rights were reviewed only in some facilities and only a small
percentage of mental health workers received training related to
human rights. These measures need to be extended to all facilities.

Mental
Health
Research
Project,
http://www.dlsu.edu.ph/research/centers/sdrc/mental_health.a
sp, Date retrieved: July 3, 2014
Mental health research capacity in low and middle-income
countries is generally perceived to be low. However, there is no solid
information available regarding this concern. Aside from that, there
is no systematic identification of the researchers in the field, the
research gaps, how priorities are set, and where funding for mental
health research is sourced. There is also inadequate knowledge
about the process transforming research to policy.
Philippines mental health country profile, Bernardo Conde,

February/May 2004
The Philippines is one of the worlds most heavily populated
countries. Even though democracy was restored in 1986 after years
of occupation and dictatorship, a high level of poverty still exists and
malnutrition and communicable diseases continue to be the main
cause of morbidity. For almost 50 years people with mental disorders
have been treated in a mental hospital setting. The National Mental
Health Program aims to establish psychiatric wards in university and
private hospitals and encourage community-based mental health
care.
Health Service Delivery Profile, WHO and Department of Health,

2012 Philippines
Positioned on the western edge of the Pacific Ocean, on the
south-eastern rim of Asia, the Philippines is the second-largest
archipelago on the planet, with over 7,107 islands In 2010, the
population of the Philippines was 92.3 million, with a growth rate of
1.9% per year. There are 80 provinces, 138 cities and 1,496
municipalities and half the population (50.3%) live in urban areas,
and of that, 44% live in slums. Both urban and rural poverty are high
but steadily decreasing. The population is highly fragmented across

the islands and with 180 ethnic groups. Malays make up the majority
and there are tribes of indigenous peoples in mountainous areas
throughout the country. The majority of the population is Christian
and there is a Muslim minority concentrated in the south.
Sikolohiyang Pilipino (Filipino psychology): A legacy of Virgilio

G. Enriquez, Rogelia Pe-Pua and Elizabeth Protacio-Marcelino,
2000
Sikolohiyang Pilipino (Filipino psychology) refers to the
psychology born out of the experience, thought and orientation of the
Filipinos, based on the full use of Filipino culture and language. The
approach is one of indigenization from within whereby the
theoretical
framework
and
methodology
emerge
from
the
experiences of the people from the indigenous culture. It is based on

assessing historical and socio-cultural realities, understanding the
local language, unraveling Filipino characteristics, and explaining
them through the eyes of the native Filipino. Among the outcomes
are: a body of knowledge including indigenous concepts,
development of indigenous research methods and indigenous
personality testing, new directions in teaching psychology, and an
active participation in organizations among Filipino psychologists
and social scientists, both in the Philippines and overseas.
Causes of Mental Disorder, Philippines Psychiatric Association,

http://www.ppa.org.ph/ , Date retrieved July 5, 2014
Knowing somebody that has a mental disorder is really
unusual. Probably because the words mental and disorder give
you an idea that its a sickness that has a low to no chance of getting
cured. Many people tend to think that if someone has a mental
disorder, then he or she is crazy. Its not always like that. What is
mental disorder anyway? This is a psychological pattern that causes
an person to not act and not become a part of the normal culture. A
behavioral pattern in one individual is also considered a mental
disorder.

Critical Psychology in the Philippines, Lourdes Angela K.

Florendo-Piero, Alpha Marilag C. Abejaron, Myra VivaresWaddington, Frederick David Abraham, November 2011- March
2012, July 20, 2014
There are many pathological features of Philippine culture that
are either caused or exacerbated by the debilitating effects of
neocolonial dynamics. These effects include endemic poverty,
endemic corruption, diasporic deployment of Filipino labor, trafficking
of women and children, exploitation and destruction of indigenous
cultures, the paradoxical increase in nationalism coexisting with the
desire to leave the Philippines, the consumption of cosmetic
bleaching, feelings of failure and learned helplessness, lack of selffulfillment, feelings of inferiority not Louanne, Alpha, Myra, & Fred 2
Critical Pschology in the Philippines only among the urban, rural, and
mountain poor, but also within Christian and Moslem cultures as well.
C. Facility Operations
1. Nursing and Service Standards
In a guideline for nursing homes in Florida, there are several
identified principles that governs the state. The government have
passed the following criteria and design recommendations to ensure
quality of service.
a. Facility Policies
Admission, retention, transfer, and discharge policies:

o Each resident will receive, at the time of admission and
as changes are being made and upon request, in a
language the resident or his representative understands:
A copy of the residents bill of rights conforming to

the requirements in Section 400.022, F.S.;

A copy of the facilitys admission and discharge

policies; and
Information regarding advance directives.
o Each resident admitted to the facility shall have a contract

in accordance with Section 400.151, F.S., which covers:
A list of services and supplies, complete with a list

of standard charges, available to the resident, but
not covered by the facilitys per diem or by Title
XVIII and Title XIX of the Social Security Act and
the bed reservation and refund policies of the
facility.
When a resident is in a facility offering continuing

care, and is transferred from independent living or
assisted living to the nursing home section, a new
contract need not be executed; an addendum shall
be attached to describe any additional services,
supplies or costs not included in the most recent
contract that is in effect.5
No resident who is suffering from a communicable

disease shall be admitted or retained unless the
medical director or attending physician certifies
that adequate or appropriate isolation measures
are available to control transmission of the
disease.
Residents may not be retained in the facility who

require services beyond those for which the facility
is licensed or has the functional ability to provide
as determined by the Medical Director and the
Director of Nursing in consultation with the facility
administrator.
Specific Authority 400.141, 400.141(7), 400.23, 765.110 FS. Law Implemented 400.022, 400.0255, 400.102, 400.141,
400.141(7), 400.151, 400.23, 765.110 FS. HistoryNew 41-82, Amended 4-1-84, Formerly 10d-29.106, Amended 4-1894, 1-10-95, 2-6-97, 5-5- 02. From: http://www.hpm.umn.edu/nhregsplus/NHRegs_by_State/Florida

Residents shall be assigned to a bedroom area

and shall not be assigned bedroom space in
common
areas
except
in
an
emergency.
Emergencies shall be documented and shall be for

a limited, specified period of time.
All resident transfers and discharges shall be in

accordance
with
the
facilitys
policies
and
procedures, provisions of Sections400.022 and

400.0255, F.S., this rule, and other applicable
state and federal laws and will include notices
provided to residents which are incorporated by
reference by using AHCA Form 3120-0002, 31200002A, Revised, May, 2001, Nursing Home
Transfer and Discharge Notice, and 3120-0003,
Revised, May, 2001, Fair Hearing Request for
Transfer or Discharge From a Nursing Home, and
3120-0004, Revised, May, 2001, Long-Term Care
Ombudsman Council Request for Review of
Nursing Home Discharge and Transfer. These
forms may be obtained from the Agency for Health
Care Administration, Long Term Care Unit, 2727
Mahan Drive, MS 33, and Tallahassee, FL 32308.
The Department of Children and Family Services
will assist in the arrangement for appropriate
continued care, when requested.
Each nursing home facility shall adopt, implement, and maintain

written policies and procedures governing all services provided
in the facility.6
All policies and procedures shall be reviewed at least annually

and revised as needed with input from, at minimum, the facility
Administrator, Medical Director, and Director of Nursing.
Each facility shall maintain policies and procedures in the

following areas:
Ibid

o Activities
o Advance directives
o Consultant services
o Death of residents in the facility
o Dental services
o Staff education
o Diagnostic services
o Dietary services
o Disaster preparedness
o Fire prevention and control
o Housekeeping
o Infection control
o Laundry service
o Loss of power, water, air conditioning or heating
o Medical director/consultant services
o Medical records
o Mental health
o Nursing services
o Pastoral services
o Pharmacy services
o Podiatry services
o Resident care planning
o Resident identification
o Residents rights

o Safety awareness
o Social services
o Specialized rehabilitative and restorative services
o Volunteer services; and
o The reporting of accidents or unusual incidents involving
any resident, staff member, volunteer or visitor.7
Staff Education.
o Each nursing home shall develop, implement, and maintain a

written staff education plan which ensures a coordinated program
for staff education for all facility employees. The staff education
plan shall be reviewed at least annually by the quality assurance
committee and revised as needed.
o The staff education plan shall include both pre-service and inservice programs.
o The staff education plan shall ensure that education is conducted
annually for all facility employees, at a minimum, in the following
areas:
Prevention and control of infection
Fire prevention, life safety, and disaster preparedness
Accident prevention and safety awareness program
Residents rights
o The staff education plan shall ensure that all nonlicensed

employees of the nursing home complete an initial educational
course on hiv/aids. If the employee does not have a certificate of
completion at the time they are hired, they must have two hours
within six months of employment or before the staff provides care
for an hiv/aids diagnosed resident. All employees shall have a
minimum of one hour biennially.
Ibid

Advance directives.
o Each nursing home shall have written policies and procedures,

which delineate the nursing homes position with respect to the
state law and rules relative to advance directives. The policies
shall not condition treatment or admission upon whether or not
the individual has executed or waived an advance directive. In
the event of conflict between the facilitys policies and procedures
and the individuals advance directive, provision should be made
in accordance with Section 765.308, F.S.
The facilitys policy shall include:
o Providing each adult individual, at the time of the admission as a

resident, with a copy of Health Care Advance Directives The
Patients Right to Decide, as prepared by the Agency for Health
Care Administration, 2727 Mahan Drive, Tallahassee, FL 32308,
effective 1-11-93, which is hereby incorporated by reference, or
with a copy of some other substantially similar document which is
a written description of Floridas state law regarding advance
directives:
o Providing each adult individual, at the time of the admission as a
resident, with written information concerning the nursing homes
policies respecting advance directives; and
o The requirement that documentation of the existence of an
advance directive be contained in the medical record.
A nursing home which is provided with the individuals
advance directive shall make the advance directive or a copy thereof
a part of the individuals medical record.8
b. Physician Services
Each nursing home facility shall retain, pursuant to a written

agreement, a physician licensed under Chapter 458 or 459, F.S.,
to serve as Medical Director. In facilities with a licensed capacity
Ibid

of 60 beds or less, pursuant to written agreement, a physician

licensed under Chapter 458 or 459, F.S., may serve as Medical
Consultant in lieu of a Medical Director.
Each resident or legal representative, shall be allowed to select

his or her own private physician.
Verbal orders, including telephone orders, shall be immediately

recorded, dated, and signed by the person receiving the order.
All verbal treatment orders shall be countersigned by the
physician or other health care professional on the next visit to
the facility.
Physician orders may be transmitted by facsimile machine. It is

not necessary for a physician to re-sign a facsimile order when
he visits a facility.
All physician orders shall be followed as prescribed, and if not

followed, the reason shall be recorded on the residents medical
record during that shift.
Each resident shall be seen by a physician or another licensed

health professional acting within their scope of practice at least
once every 30 days for the first 90 days after admission, and at
least once every 60 days thereafter. A physician visit is
considered timely if it occurs not later than 10 days after the date
the visit was required. If a physician documents that a resident
does not need to be seen on this schedule and there is no other
requirement for physicians services that must be met due to title
xviii or xix, the residents physician may document an alternate
visitation schedule.
If the physician chooses to designate another health care

professional to fulfill the physicians component of resident care,
they may do so after the required visit. All responsibilities of a
physician, except for the position of medical director, may be
carried out by other health care professionals acting within their
scope of practice.

Each facility shall have a list of physicians designated to provide

emergency services to residents when the residents attending
physician, or designated alternate is not available.9
c. Medical Director
Each facility will have only one physician who is designated as

Medical Director.
The Medical Director must be a physician. The nursing home

administrator may require that the Medical Director be certified or
credentialed through a recognized certifying or credentialing
organization.
A physician may be Medical Director of a maximum of 10 nursing

homes at any one time. The Medical Director, in an emergency
where the health of a resident is in jeopardy and the attending
physician or covering physician cannot be located, may assume
temporary responsibility of the care of the resident and provide
the care deemed necessary.
The Medical Director appointed by the facility shall meet at least

quarterly with the quality assessment and assurance committee
of the facility.
The Medical Director appointed by the facility shall participate in

the development of the comprehensive care plan for the resident
when he/she is also the attending physician of the resident.10
d. Nursing Services
The Administrator of each nursing home will designate one full

time registered nurse as a Director of Nursing who shall be
responsible
and
accountable
for
the
supervision
and
Specific Authority 400.23 FS. Law Implemented 400.022, 400.102, 400.141, 400.23, 464.012 FS. HistoryNew 4-1-82,
Amended 4-1- 84, Formerly 10d-29.107, Amended 10-5-92, 4-18-94, 1-10-95. From:
http://www.hpm.umn.edu/nhregsplus/NHRegs_by_State/Florida
10 Specific Authority 400.141 FS. Law Implemented 400.141(2) FS. HistoryNew 8-2-01. From:

administration of the total nursing services program. When a

director of nursing is delegated institutional responsibilities, a full
time qualified registered nurse shall be designated to serve as
Assistant Director of Nursing. In a facility with a census of 121 or
more residents, an RN must be designated as an Assistant
Director of Nursing.
Persons designated as Director of Nursing or Assistant Director

of Nursing shall serve only one nursing home facility in this
capacity, and shall not serve as the administrator of the nursing
home facility.
The Director of Nursing shall designate one licensed nurse on

each shift to be responsible for the delivery of nursing services
during that shift.
The nursing home facility shall have sufficient nursing staff, on a

24-hour basis to provide nursing and related services to
residents in order to maintain the highest practicable physical,
mental, and psychosocial well-being of each resident, as
determined by resident assessments and individual plans of
care. The facility will staff, at a minimum, an average of 1.7 hours
of certified nursing assistant and .6 hours of licensed nursing
staff time for each resident during a 24 hour period.
In multi-story, multi-wing, or multi-station nursing home facilities,

there shall be a minimum of one nursing services staff person
who is capable of providing direct care on duty at all times on
each floor, wing, or station.
No nursing services staff person shall be scheduled for more

than 16 hours within a 24 hour period, for three consecutive
days, except in an emergency. Emergencies shall be
documented and shall be for a limited, specified period of time.11
11
Specific Authority 400.022, 400.23 FS. Law Implemented 400.011, 400.022, 400.141, 400.23 FS. HistoryNew 4-1-82,
Amended 4-1-84, 8-1-85, 7-1-88, 7-10-91, Formerly 10D-29.108, Amended 4-18-94. From:

e. Resident Assessment and Care Plan
Each resident admitted to the nursing home facility shall have a

plan of care. The plan of care shall consist of:
Physicians orders, diagnosis, medical history, physical exam

and rehabilitative or restorative potential.
o A preliminary nursing evaluation with physicians orders
for immediate care, completed on admission.
o A complete, comprehensive, accurate and reproducible
assessment of each residents functional capacity which
is standardized in the facility, and is completed within 14
days of the residents admission to the facility and every
twelve months, thereafter.
o The assessment shall be:
Reviewed no less than once every 3 months,
Reviewed promptly after a significant change in

the residents physical or mental condition,
Revised as appropriate to assure the continued

accuracy of the assessment.
The facility is responsible to develop a comprehensive care plan

for each resident that includes measurable objectives and
timetables to meet a residents medical, nursing, mental and
psychosocial needs that are identified in the comprehensive
assessment. The care plan must describe the services that are
to be furnished to attain or maintain the residents highest
practicable physical, mental and social well-being. The care plan
must be completed within 7 days after completion of the resident
assessment.
At the residents option, every effort shall be made to include the

resident and family or responsible party, including private duty
nurse or nursing assistant, in the development, implementation,
maintenance and evaluation of the resident plan of care.

All staff personnel who provide care, and at the residents option,
private duty nurses or non-employees of the facility, shall be
knowledgeable of, and have access to, the residents plan of
care.
A summary of the residents plan of care and a copy of any

advanced directives shall accompany each resident discharged
or transferred to another health care facility, or shall be
forwarded to the receiving facility as soon as possible consistent
with good medical practice.12
f. Dietary Services
The Administrator must designate one full-time person as a

Dietary Services Supervisor. In a facility with a census of 61 or
more residents, the duties of the Dietary Services Supervisor
shall not include food preparation or service on a regular basis.
The Dietary Services Supervisor shall either be a qualified

dietitian or the facility shall obtain consultation from a qualified
dietitian. A qualified dietitian is one who:
o Is a registered dietitian.
o Has a baccalaureate degree with major studies in food
and nutrition, dietetics, or food service management, has
one year of supervisory experience in the dietetic service
of a health care facility, and participates annually in
continuing dietetic education.
A Dietary Services Supervisor shall be a person who:

o Has successfully completed a course offered by an
accredited college or university that provided 90 or more
hours of correspondence or classroom instruction in food
service supervision, and has prior work experience as a
Dietary Supervisor in a health care institution with
consultation from a qualified dietitian; or
12
Specific Authority 400.23 FS. Law Implemented 400.022, 400.102, 400.141, 400.23 FS. HistoryNew 4-1-82,
Amended 4-1-84, Formerly 10D-29.109, Amended 4-18-94, 1-10-95. From:

o Has training and experience in food service supervision

and management in the military service equivalent in
content to the program in paragraph.
A one-week supply of a variety of non-perishable food and

supplies, that represents a good diet, shall be maintained by the
facility.13
g. Pharmacy Services.
The facility shall adopt procedures that assure the accurate

acquiring, receiving, dispensing, and administering of all drugs
and biologicals, to meet the needs of each resident.
The facility shall employ, or obtain, the services of a state

licensed consultant pharmacist.
The consultant pharmacist shall establish a system to accurately

record the receipt and disposition of all controlled drugs in
sufficient detail to enable an accurate reconciliation.
The pharmacist shall determine that drug records are in order

and that an account of all controlled drugs is maintained and
periodically reconciled.
Drugs and biologicals used in the facility shall be labeled in

accordance with currently accepted professional principles.
Drugs and non-prescription medications requiring refrigeration

shall be stored in a refrigerator. When stored in a general-use
refrigerator, they shall be stored in a separate, covered,
waterproof, and labeled receptacle.
All controlled substances shall be disposed of in accordance with

state and federal laws. All non-controlled substances may be
destroyed in accordance with the facilitys policies and
procedures. Records of the disposition of all substances shall be
13
Specific Authority 400.022(1)(a), (f), (g), 400.141(5), 400.23 FS. Law Implemented 400.022, 400.102, 400.141,
400.23 FS. History New 4-1-82, Amended 4-1-84, 7-1-88, 7-10-91, Formerly 10D-29.110, Amended 4-18-94, 2-6-97.
From: http://www.hpm.umn.edu/nhregsplus/NHRegs_by_State/Florida

maintained
in
sufficient
detail
to
enable
an
accurate
reconciliation.
Non-controlled substances, in unit dose containers, may be

returned to the dispensing pharmacy.
If ordered by the residents physician, the resident may, upon

discharge, take all current prescription drugs with him. An
inventory of the drugs released shall be completed, shall be
dated, and signed by both the person releasing the drugs and
the person receiving the drugs, and shall be placed in the
residents record.
The facility shall maintain an Emergency Medication Kit, the

contents of which shall be determined in consultation with the
Medical Director, Director of Nursing and Pharmacist, and it shall
be in accordance with facility policies and procedures. The kit
shall be readily available and shall be kept sealed. All items in
the kit shall be properly labeled. The facility shall maintain an
accurate log of receipt and disposition of each item in the
Emergency Medication Kit. An inventory of the contents of the
Emergency Medication Kit shall be attached to the outside of the
kit. If the seal is broken, the kit must be resealed the next
business day after use.14
h. Medical Records
The facility shall designate a full-time employee as being

responsible and accountable for the facilitys medical records. If
this employee is not a qualified Medical Record Practitioner, then
the facility shall have the services of a qualified Medical Record
Practitioner on a consultant basis.
Each medical record shall contain sufficient information to clearly

identify the resident, his diagnosis and treatment, and results.
14
Specific Authority 400.23 FS. Law Implemented 400.022, 400.102, 400.141, 400.23 FS. HistoryNew 4-1-82,
Amended 4-1-84, 7-1091, Formerly 10D-29.112, Amended 4-18-94. From: http://www.hpm.umn.edu/nhregsplus/NHRegs_by_State/Florida

Medical records shall be complete, accurate, accessible and

systematically organized.
Medical records shall be retained for a period of five years from

the date of discharge. In the case of a minor, the record shall be
retained for 3 years after a resident reaches legal age under
state law.15
i. Physical Environment
The facility shall provide a safe, clean, comfortable, and homelike

environment, which allows the resident to use his or her personal
belongings to the extent possible.
The facility shall provide:

o Housekeeping and maintenance services necessary to
maintain a sanitary, orderly, and comfortable interior;
o Clean bed and bath linens that are in good condition;
o Private closet space for each resident;
o Furniture, such as a bed-side cabinet, drawer space;
o Adequate and comfortable lighting levels in all areas;
o Comfortable and safe temperature levels; and
o The maintenance of comfortable sound levels. Individual
radios, TVs and other such transmitters belonging to the
resident will be tuned to stations of the residents choice.16
2. Quality Care Standards

Patients will experience quality care and support when they are
fully informed and involved in all decisions affecting their life and care,
15
Specific Authority 400.23 FS. Law Implemented 400.022, 400.102, 400.141, 400.145, 400.23 FS. HistoryNew 4-1-82,
Amended 4-1- 84, 3-2-88, Formerly 10D-29.118, Amended 4-18-94.
16 Specific Authority 400.23 FS. Law Implemented 400.102, 400.141, 400.23 FS. HistoryNew 4-1-82, Amended 4-1-84,
Formerly 10D-29.122, Amended 4-18-94.

and they can contribute to the planning and evaluation of services. A key
principle within these standards is that people in receipt of services must
be central in all aspects of planning, delivery and review of their care.
Having a caring, open and responsive approach in a home is key
to the delivery of quality services. These minimum standards promote
the empowerment of patients and strongly encourage proactive
engagement and a listening partnership with patients to ensure they feel
involved in, and can influence, the operation of the home. The use of
both informal feedback mechanisms and more formal arrangements,
and, where necessary, enlisting local advocacy services to gain patients
and relatives views about the services provided will provide managers
and staff with essential information about improvements that can be
made. Listening and responding to compliments, comments and
complaints is a vital part of this process.
Maintaining or making links with the local community is very
important and helps patients build and retain their positive sense of
worth. Knowledge of, and a respect for, patients interests and preferred
way of life, and listening and responding to their suggestions, will help
determine the content of a creative and interesting program of events
and activities. Artlessness and flexibility are also essential for any good
program. Mealtimes are an opportunity for some patients to meet others
and catch up with events taking place in the home. The presentation of
food and the decoration in dining areas should reflect the importance of
the social aspect of mealtimes.
Before being admitted to a home, prospective patients and their
relatives need information about the home. They can gain this through
visiting the home and talking to other patients living there, and by
consulting with staff and management. They can also obtain information
by reading the Patients Guide and reports made about the home by
the Regulation and Quality Improvement Authority. To enable patients
to make informed choices and retain as much control as possible over
their own affairs, homes are expected to have open and transparent
arrangements for all their services. Homes are also expected to provide

all relevant information 10 in suitable formats. Individual agreements will

clarify what is expected for each patient.17
a. Nursing care
The nursing care standards apply to all nursing home settings
and aim to promote and maintain maximum independence and
rehabilitation for patients. Care in the nursing home should be
provided within a structured, continuous, nursing-led process that
involves patients, their representatives, and relevant health
professionals working in supportive partnerships.
This process should commence with a comprehensive
assessment of a patients holistic care needs prior to, and on,
admission to the home. This assessment should guide the
development of a multi-disciplinary, patient focused, documented and
structured care plan that meets the assessed needs of the patient.
All aspects of the delivery of care, interventions and
procedures must be outcome based and allow for regular systematic
review, evaluation and bench marking that takes account of the
comments and views of patients, their representatives and others.
The development of basic nursing care standards for nursing
homes began with a review of the fundamentals of good quality care
as described in the Essence of Care benchmarking document. This
resulted in the identification of key issues relating to nutrition, skin
care, promotion of continence and safety as the basic requirements
that must be met for patients in any nursing home setting.
The implementation of interventions, activities and procedures
to meet the more complex needs of patients who are living with
chronic disorders, medical illness and mental health conditions must
be carried out by nurses who have appropriate education and skills to
recognise specific needs of patients. These nurses must also have
access to relevant guidelines and research evidence, as defined by
17
Department of Health, Social Services and Public Safety January 2008 Nursing Homes Minimum Standards, , pp. 9 10, Retrieved from www.dhsspsni.gov.uk

professional bodies and national standard setting organizations, to

support their practice.
Where a nursing home provides palliative care, there is a need
to respond to issues in a timely way, and also the often complex and
diverse holistic care needs of both the patient and their families need
to be met. The nursing home must have arrangements in place to
access the services of a multi-professional team that is focused and
skilled in meeting patients physical, psychological, social and
religious and cultural needs.
In order to support nursing practices that meet the nursing care
needs of all patients, the registered manager has responsibility for
ensuring that:
Nursing policies, procedures, protocols and guidelines are

developed in accordance with best practice guidelines and
research evidence, as defined by professional bodies and
national standard setting organizations
Nurses have appropriate education and skills to recognise

specific needs of patients, and have access to relevant guidelines
and research evidence, as defined by professional bodies and
national standard setting organizations, to support their practice
Holistic care is provided through working collaboratively with

other professions
Working relationships are developed between staff, patients and

their representatives that promote informed decision-making and
autonomy for patients
Arrangements are in place to ensure that staff communicate

effectively with patients taking account of their hearing and visual
abilities, other physical and cognitive abilities, and their preferred
language (with the need for an interpreter where appropriate)
Patients expressed needs and preferences for confidentiality are

paramount
in
any
communication
with
family
and
representatives.

Against this background, there is the need for registered

providers to be committed to continuous improvement and to meeting
the Minimum Standards, thereby providing the best care and life
opportunities to the patients living in the nursing home.18
b. Patients Involvement
Standard: Patients views and comments shape the quality of
services and facilities provided by the home.
Criteria
The values that underpin the standards inform the philosophy of

care and staff consistently demonstrate the integration of these
values within their practice.
Patients views are taken into account in all matters affecting

them and the home has forums or systems where patients and
their representatives can express their views and be consulted
about the running of the home.
Patients are involved in decisions affecting the quality of their

care and life in the home, including the introduction or review of
the homes routines, practices and policies and procedures.
Suggestions made regarding improvements, compliments given

and issues raised by patients and their representatives regarding
the quality of services and facilities provided are listened and
responded to.
A record is made of the matters raised by the patients and their

representatives and the action taken.
The views and opinions of patients and their representatives

about the running of the home are sought formally at least once
a year, preferably by an organization or person independent of
the home.
18
Ibid

A report is prepared that identifies the methods used to obtain the

views and opinions of patients and their representatives, which
incorporates the comments made and issues raised and any
actions to be taken for improvement. A copy of this report is
provided to patients and their representatives.
Patients and their representatives are informed about planned

inspections by the Regulation and Quality Improvement
Authority and of the arrangements for them to give their views
about the home to the inspectors.19
c. Contact with family, friends and the community

Standard: Contact with family, friends and the local community
is facilitated for patients.
Criteria
Each patient is encouraged and facilitated to maintain, as far as

possible, their existing links with family, friends and the local
community.
Patients can have visitors at any reasonable time, and if there

are restrictions these are made known and explained to those
concerned.
There are facilities for patients to receive visitors in private if they

wish and these are offered as necessary.
When agreed by the patient, their family and friends have

opportunities to be involved in the patients daily life.
Each patients right to develop and maintain intimate personal

relationships with people of their choice is respected, unless a
patient is assessed as lacking the capacity to consent to such a
relationship. If such a situation occurs, information and guidance
is sought on ensuring their protection.
19Ibid,
pp. 12-13

Patients are consulted about visits by community groups and

volunteers, and the manager or senior member of staff on duty
monitors these visits to ensure they benefit patients.
Each patients existing links with family, friends and the local
community are identified and recorded at the time of their
admission to the home.20
d. Admission to the home

Standard: Admission to the home is planned to facilitate a
smooth introduction to the home for all patients.
Prospective patients, or their representatives, are given a

Patients Guide that provides comprehensive, up-to-date
information about the home and the services provided. The
information is available, if required, in a format and language
suitable for the prospective patient or their representative.
The patients guide contains information on the following

areas/subjects:
o A summary of the statement of purpose, and services and
facilities provided
o Location and description of the home
o The name of the registered manager and the general staffing
arrangements
o The current program of activities and events
o The charges for specific services and facilities, and if
necessary, any activities and events that have costs
o The arrangements for patient involvement in the running of
the home
20Ibid,
pp. 14

o The views of patients and their representatives on the quality

of services and facilities
o The general terms and conditions of living in the home
o The arrangements for inspection of the home and details on
how to access inspection reports
o The organization, its structure and the name of the registered
person
o The referral and admission procedures.
Arrangements are in place for prospective patients, or their

representatives, to visit and assess the suitability of the home prior
to admission.
The manager ensures that referral forms providing all necessary

information, including any risk assessment relating to the patient and
the delivery of their care and services, is completed before
admission. Any documents from the referring Trust are dated and
signed when received.
There are arrangements in place for responding to, and ensuring

appropriate placement for, self-referred patients.
For any unplanned admission, a referral form is obtained or

completed within two working days of the patient being admitted.
When referral information is not received, records are kept of
requests made for it.
An identified nurse employed by the nursing home visits the patient,

carries out and records an assessment of nursing care needs (using
validated assessment tools), prior to admission. Information received
from other care providers, if appropriate, is used in this assessment.
Any associated factors or risks are documented.
Where the home is acting in response to a self-referred patient, the

manager advises the patient, or their representative, to contact the
local Trusts care management service.21
21
Ibid, pp. 15-16


e. Individual agreement
Standard: Each patient has an individual written agreement
setting out the terms of residency regarding the services and facilities
to be provided.
Criteria
Each patient, or their representative, is provided with an

individual written agreement that sets out their terms of residency.
The agreement is made available, if required, in a format and
language suitable for the patient, or their representative.
The agreement sets out, at a minimum:

o The date of admission and the duration of the stay, if known
o The accommodation, services and facilities provided by the
home (these are the general services and facilities agreed
through contracting arrangements with a HSC Trust), the
weekly fee plus an itemized list of all agreed services and/or
facilities over and above the general services and facilities
o The individual charges for all the agreed itemized services
and facilities, arrangements for the payment of all agreed
charges and the minimum period of notice for any change to
the charges
o The arrangements for any financial transactions undertaken
on behalf of the patient by the home and the records to be
kept
o The general terms and conditions of residency with reference
to any of the homes relevant policies
o The arrangements for the management of the patients
valuables, if any
o A copy of the homes complaints procedure

o The arrangements for regularly reviewing the signed

agreement and the circumstances when the agreement can
be reviewed outside these arrangements
o The frequency of summary reports (for persons staying for
respite care)
o The period of notice for terminating the agreement.
The agreement is in place before admission, or, if this is not

possible, it is in place within five working days of the date of
admission.
The patient, or their representative, and the registered person

sign the agreement prior to, or within five working days of,
admission. Where the patient, or their representative, is unable
or chooses not to sign, this is recorded.
For patients who are admitted to the home on an unplanned

basis, the agreement is signed within two weeks of admission.
The patient, or their representative, is given written notice of all

changes to the agreement and these are agreed in writing by the
patient, or their representative. Where the patient, or their
representative, is unable or chooses not to sign, this is recorded.
A minimum of four week notice is given for the introduction of new

charges for services and facilities, together with a statement for
such an increase.
Charges are levied in accordance with current DHSSPS

guidelines on the care assessment process.22
f. Nursing care standard

Standard: Patients receive safe, effective nursing care based
on a holistic assessment of their care needs that commences prior to
admission to the home and continues following admission. Nursing
22
Ibid , pp. 17-18


care is planned and agreed with the patient, is accurately recorded

and outcomes of care are regularly reviewed.
Criteria
At the time of each patients admission to the home, a nurse

carries out and records an initial risk assessment, using a
validated assessment tool, and draws up an agreed plan of care
to meet the patients immediate care needs. Information received
from the care management team informs this assessment.
A comprehensive, holistic assessment of the patients care needs

using validated assessment tools is completed within 11 days of
admission.
A named nurse has responsibility for discussing, planning and

agreeing nursing interventions to meet identified assessed needs
with individual patients and their representatives. The nursing
care plan clearly demonstrates the promotion of maximum
independence and rehabilitation and, where appropriate, takes
into account advice and recommendations from relevant health
professionals.
Re-assessment is an on-going process that is carried out daily

and at identified, agreed time intervals as recorded in nursing
care plans.
All nursing interventions, activities and procedures are supported

by research evidence and guidelines as defined by professional
bodies and national standard setting organizations.
Contemporaneous nursing records, in accordance with NMC

guidelines, are kept of all nursing interventions, activities and
procedures that are carried out in relation to each patient. These
records include outcomes for patients.
The outcome of care delivered is monitored and recorded on a

day-to-day basis and, in addition, is subject to documented
review at agreed time intervals and evaluation, using benchmarks
where appropriate, with the involvement of patients and their
representatives.

Patients are encouraged and facilitated to participate in all

aspects of reviewing outcomes of care and to attend, or
contribute to, formal multi-disciplinary review meetings arranged
by local HSC Trusts as appropriate.
The results of all reviews and the minutes of review meetings are
recorded and, where required, changes are made to the nursing
care plan with the agreement of patients and representatives.
Patients, and their representatives, are kept informed of progress
toward agreed goals.23
g. Completion of case records

Standard: Patients case records are accurate and up to date.
Criteria
The policy and procedure for maintaining case records in relation

to treatment and care provided for patients complies with
guidelines from professional and regulatory bodies.
All entries in case records are contemporaneous; dated, timed,

and signed, with the signature accompanied by the name and
designation of the signatory.
Any alterations or additions are dated, timed and signed, and

made in such a way that the original entry can still be read.
All treatment given and recommendations made are recorded in

case records.24
h. Consent to examination, treatment and care

Standard: Patients consent to examination, treatment and
care is obtained in accordance with policies and procedures.
23
24
Ibid, pp. 19-20

Ibid, p. 21

Criteria
The consent policy and procedures include how to obtain consent

and what to do if a patient lacks capacity to give valid consent, or
withdraws consent.
Nursing procedures are explained to patients, and their

representatives, informing them of the implications of the
treatment and any options available to them. This is documented
in nursing care records.
Procedures for obtaining consent are in accordance with the

DHSSPS, NMC and professional regulatory bodies guidance.
Completed written consent forms, where used, are maintained

within individual case records.25
i. Nutrition
Standard: Nutritional needs of patients are met.
Nutritional screening is carried out with patients on admission, using

a validated tool such as the Malnutrition Universal Screening Tool
(MUST) or equivalent.
Nutritional screening is repeated monthly, or more frequently

depending on individual assessed need, and nutritional support is
implemented according to the screening protocol.
There are referral arrangements for the dietitian to assess individual

patients nutritional requirements and draw up a nutritional treatment
plan. The nutritional treatment plan is developed taking account of
recommendations from relevant health professionals, and these
plans are adhered to.
There are up to date nutritional guidelines that are used by staff on

a daily basis.
25
Ibid, p. 22

There is nutritional information available in an accessible format for

patients, and their representative.
Nurses have up-to-date knowledge and skills in managing feeding

techniques for patients who have swallowing difficulties, and in
ensuring that instructions drawn up by the speech and language
therapist are adhered to.
Nurses have up-to-date knowledge and skills in the provision of

enteral tube feeding, and ensuring that feeding regimens drawn up
by the dietitian are adhered to.26
j. Referral to community health and social care professionals

Standard: There are arrangements for referring patients to
community health and social care professionals as required.
Details of each patients registration with health and social care

professionals, for example a GP, optometrist or dentist are recorded,
and arrangements are in place for patients to be provided with
information and support when applying for reregistration or new
registration to these services.
The frequency of appointments for health screening, dental,

optometry, podiatry and other community healthcare professionals
are monitored and referrals are made as required.
The general health and welfare of patients is continually monitored

and recorded, and referrals are made to, or advice sought from,
appropriate health and social care professionals where necessary,
and documented in the patients records.
Where appropriate, and with the patients consent, the patients

representative is provided with feedback from health and social care
appointments and informed about any follow up care required.
26
Ibid, p. 23

There are systems for maintaining patients spectacles, dentures,

personal equipment and appliances, so that they provide maximum
benefit for each patient.27
k. Responding to patients behavior

Standard: Responses to patients are appropriate and based
on an understanding of individual patients conduct, behavior and
means of communication.
Criteria
The procedures for responding to patients behavior promote

positive outcomes for patients and are based on members of staff
having knowledge and understanding of patients usual conduct,
behavior and means of communication.
When a patients behavior is uncharacteristic and causes

concern, a documented plan of care that meets the individuals
assessed needs and comfort is drawn up and agreed with
patients, their representatives and relevant professionals, as
required.
Behavior management programs are only implemented as a

result of a multi-disciplinary team decision in agreement with
relevant professionals, patients and their representatives, in
accordance with good practice guidelines and procedures, with
full details recorded in the individuals care plan.
When
employing
behavior
management,
nurses
are
appropriately trained to ensure they use the procedures to

promote the wellbeing and best interests of patients.
There are up to date guidelines on behavior management

programs that are evidence based and in line with current best
practice, as defined by professional bodies and standard setting
organizations.
27
Ibid, p.24

Team reviews of all behavior management interventions are held

and used to provide learning and practice development.
Restraint is only used as a last resort by appropriately trained

staff to protect the patient or other persons when other less
restrictive strategies have been unsuccessful. Records are kept
of all instances when restraint is used.28
l. Meals and mealtimes

Standard: Patients receive a nutritious and varied diet in
appropriate surroundings at times convenient to them.
Criteria
Patients are provided with a nutritious and varied diet, which

meets their individual and recorded dietary needs and
preferences. Full account is taken of relevant guidance
documents, or guidance provided by dietitians and other
professionals and disciplines.
Patients are involved in planning the menus.
The menu either offers patients a choice of meal at each

mealtime or, when the menu offers only one option and the
patient does not want this, an alternative meal is provided. A
choice is also offered to those on therapeutic or specific diets.
The daily menu is displayed in a suitable format and in an

appropriate location, so that patients, and their representatives,
know what is available at each mealtime.
Meals are provided at conventional times, hot and cold drinks and
snacks are available at customary intervals and fresh drinking
water is available at all times.
Patients can have a snack or drink on request, or have access to

a domestic style kitchen.
28
Ibid, p. 25

Menus provide for special occasions.
Patients are consulted and their views taken into account

regarding the homes policy on take away foods.
Meals are served in suitable portion sizes, and presented in a

way and in a consistency that meets each patients needs.
Staff are aware of any matters concerning patients eating and

drinking as detailed in each patients individual care plan, and
there are adequate numbers of staff present when meals are
served to ensure:
Risks when patients are eating and drinking are managed
Required assistance is provided
Necessary aids and equipment are available for use.
A record is kept of the meals provided in sufficient detail to enable

any person inspecting it to judge whether the diet for each patient
is satisfactory.
Where a patients care plan requires, or when a patient is unable,

or choses not, to eat a meal, a record is kept of all food and drinks
consumed. Where a patient is eating excessively, a similar record
is kept. All such occurrences are discussed with the patient and
reported to the nurse in charge. Where necessary, a referral is
made to the relevant professionals and a record kept of the action
taken.
Variations to the menu are recorded.
Menus are rotated over a three-week cycle and revised at least

six-monthly, taking into account seasonal availability of foods and
patients views.29
m. Program of activities and events
29
Ibid, pp. 27-28


Standard 13: The home offers a structured program of varied

activities and events, related to the statement of purpose and
identified needs of patients.
Criteria
The program of activities and events provides positive outcomes

for patients and is based on the identified needs and interests of
patients.
The program includes activities that are enjoyable, purposeful

and age and culturally appropriate for patients and takes into
account the patients spiritual needs. It promotes healthy living,
is flexible and responsive to patients changing needs, and
facilitates social inclusion in community events.
Patients, including those patients who generally stay in their

rooms, are given the opportunity to contribute suggestions and
to be involved in the development of the program of activities.
The program of activities is displayed in a suitable format and in

an
appropriate
location,
so
that
patients,
and
their
representatives, know what is scheduled (Small homes

excepted).
Patients are enabled to participate in the program through the

provision of equipment, aids and support from staff or others.
The duration of each activity and the daily timetable takes into
account the needs and abilities of the patients participating.
Where an activity is provided by a person who is contracted in to

do so by the home, the registered manager either obtains
evidence from the person or monitors the activity to confirm that
those delivering or facilitating activities have the necessary skills
to do so.
Where an activity is provided by a person contracted in to do so

by the home, staff inform them about any changed needs of
patients prior to the activity commencing, and there is a system
in place to receive timely feedback.

A record is kept of all activities that take place, the names of

persons leading each activity and the patients who participate.
The program is reviewed regularly, and at least twice yearly, to

ensure it meets patients changing needs.30
II.
Nursing Vessel
A. Definitions and Historical Background

Long term care as it exists today is broad in its definition and
generally refers to a range of services that support the daily needs of
individuals with limited functioning or disability (Houser 2007). Limited
functioning or disability is typically determined according to an individuals
ability to complete activities of daily living (ADLs) or instrumental activities
of daily living (IADLs). Such activities include eating, bathing and dressing,
as well as management of food, medication or household chores (Binstock,
Cluff et al. 1996).31
1. Historical Background
Historically, there has always been a need for the provision of
healthcare specific to elderly individuals and other vulnerable
populations. In medieval times, principally in the 13th century, a
movement of women based in feminism ideology and spirituality lay the
groundwork for care of the sick and needy (McDonnell 1954). Originating
in Northern Europe, these sisterhoods were called Beguines. Within
America, the beginning of care of the elderly and feeble rested in the
hands of family, and in particular, the responsibility fell to the women of
the family (Holstein and Cole 1996). By the 1900s, the colonial
almshouse became the first institution in America to resemble
institutionalized management of care for poor, elderly and disabled
(Starr 1982; Foundation 1996-2008). Given that hospitals at this time
were primarily concerned with curative and acute care, almshouses
30
Ibid, pp. 29-30

Emma Nochomovitz, n.d., Skilled Nursing Facilities and Other Long Term Care Facilities: Addressing
Issues of Cost and Quality
31

became the default care location for chronically ill elderly individuals
(Holstein and Cole 1996). The 1930s and the reign of President
Roosevelt encouraged greater acknowledgement of the needs of elderly
citizens; resulting in the establishment of Social Security and Old Age
Assistance in 1935 (Foundation 1996-2008). This administrative reform
aimed to provide elderly individuals with a steady source of income,
which would allow them to better care for themselves (Holstein and Cole
1996). While Social Security served to eliminate the need for
almshouses and the stigma associated with poverty that accompanied
these institutions, it did not remove the need for a venue for chronic care
for elderly individuals. Thus, the development of home care planning and
nursing homes emerged throughout the 1930s to the 1960s, laying the
groundwork for modern long term care (Holstein and Cole 1996).32
Since the passage of the 1935 Social Security Act, several
policies have played a significant role in the growth of the nursing home
industry, as well as its persistent efforts to cope with issues of cost and
quality. In 1950, amendments to the original Social Security Act
established standards of care through nursing home licensure
requirements and encouraged the growth of the industry through the
authorization of vendor payments (Giacalone 2001). Similarly, several
amendments to the Hill-Burton Act in 1954 influenced the growth of the
nursing home industry by providing financial backing for government
and nonprofit nursing homes (Giacalone 2001).
Public financing of healthcare in general experienced a
significant change in 1965, with the development of the Medicare and
Medicaid programs as amendments to the original Social Security Act
(Giacalone 2001). Medicare and Medicaid became significant for the
nursing home industry with the enactment of the 1967 Moss
Amendments, which authorized nursing homes to utilize the Medicaid
program (Giacalone 2001). Public Law 92-603 introduced automatic
Medicaid eligibility to all Social Security beneficiaries in 1972, leading to
greater access to Medicaid for older adults (Giacalone 2001). During this
time, a monitoring system called the Professional Standards Review
Organization was also created to maintain control over quality of care
32
Ibid

under the Medicare and Medicaid programs, including skilled nursing

care (Giacalone 2001).
The 1954 amendments to the Hill-Burton Act were among the
first policies aimed at addressing quality issues in nursing homes
(Giacalone 2001). Quality improvement in nursing homes encountered
a major change following the passage of the Nursing Home Reform Act,
which was included in the Omnibus Budget Reconciliation Act of 1987
(Wunderlich and Kohler 2001; Klauber 2001) The Nursing Home Reform
Act contributed to the evolution of quality care in nursing homes by
establishing basic services and standards for those services that nursing
home residents should be able to expect. Moreover, the Act included a
basic list of rights for nursing home residents (Wright 2001).33
2. Types of Long Term Care Facilities
A nursing home is commonly defined as a skilled nursing

facility (SNF), which provides 24-hour skilled medical care for both acute
and chronic conditions, as well as additional help for daily activities of
living (Services). Discussions of long term care most commonly refer to
these institutions.
Assisted living facilities (ALF), while sometimes similar to SNFs

in the care they provide, generally provide basic care for chronic
illnesses and some assistance with activities of daily living, while
offering greater independence and autonomy for its residents
than a SNF. ALFs emerged in the United States in the mid-1980s
and have experienced great increases in numbers.
Continuing care retirement communities (CCRC) are yet another

source of long term care for the elderly. This care setting often
includes a skilled nursing facility, but the level of care received by
each resident is dependent on his/her individual needs (Center
for Medicare and Medicaid Services.
33
Ibid

Home health care is another option that elderly individuals,

especially those with extensive support networks, may choose to
meet their long term care needs. Home health care may be
provided by close friends or family.34
3. Nursing Homes Offer
Nursing homes that have applied and used injury prevention

efforts focusing on resident lifting and repositioning methods have
achieved considerable success in reducing work-related injuries and
associated workers compensation costs. A safer and more
comfortable work environment has also resulted in additional
benefits for some facilities, including reduced staff turnover and
associated training and administrative costs, reduced absenteeism,
increased productivity, improved employee morale, and increased
resident comfort.
Providing care to nursing home residents is physically
demanding work Nursing home residents often require assistance to
walk, bathe, or perform other normal daily activities. In some cases
residents are totally dependent to caregivers for mobility. Manual
lifting and other tasks involving the repositioning of residents are
associated with an increased risk of pain and injury to caregivers,
particularly to the back. These tasks can entail high physical
demands due to the large amount of weight involved, awkward
postures that may result from leaning over a bed or working in a
confined area, shifting of weight that may occur if a resident loses
balance or strength while moving, and many other factors. The
identified the risk factors that workers in nursing homes face as to:
34
Force - the amount of physical effort required to perform a

task (such as heavy lifting) or to maintain control of
equipment or tools;
Repetition - performing the same motion or series of

motions continually or frequently; and
Awkward postures assuming positions that place stress

on the body, such as reaching above shoulder height,
Ibid

kneeling, squatting, leaning over a bed, or twisting the

torso while lifting.
The services nursing homes offer vary from facility to facility.
Services often include:
Room and board
Monitoring of medication
Personal care (including dressing, bathing, and toilet

assistance)
24-hour emergency care
Social and recreational activities35
4. Terminologies
Skilled nursing care
Care that is received in a nursing facility that provides 24-hour

nursing care for convalescent residents and those with long-term
care illnesses. It is one step below hospital acute care, and regular
medical supervision and rehabilitation therapy are usually available.
Personal care
Care that is customized to the individual needs of activities of

daily living; self-administration of medications.
Activities of daily living (ADL)
Everyday activities that include bathing, grooming, eating,

toileting, and dressing.
Instrumental activities of daily living (IADL)
Include activities such as shopping, preparing meals,

performing housework, laundering, heavy chores, managing
finances, and yard work and maintenance.
Home health care
Medical and nursing care that is administered in the

individual's home by a licensed provider.
Health maintenance organization (HMO)
A health maintenance organization is an organized system for

providing comprehensive healthcare in a specific geographic area
to a voluntarily enrolled group of members.
35
Elaine L. Chao, Secretary & John L. Henshaw Occupational Safety and Health Administration, Assistant Secretary,
2009 Guidelines for Nursing Homes Ergonomics for the Prevention of Musculoskeletal Disorders

B. Architectural Guidelines and Standards

1. Department of Health Standards and Guidelines in
the Philippines
a. Administrative Order No. 147 S. 2004
Amending Administrative Order No. 70-A, Series 2002 re: Revised
Rules and Regulations Governing the Registration, Licensure and
Operation of Hospitals and Other Health Facilities in the
Philippines
i.
Section 6. Definition: A hospital is a health facility for the

diagnosis, treatment and care of individuals suffering from
deformity, disease, illness or injury, or in need of surgical,
obstetrical, medical or nursing care. It is an institution where
there are installed bassinets or bed 24-hour use or longer by
patients in the management of deformities, disease, injuries,
abnormal physical, and mental conditions, and maternity
cases.
ii.
Section 7. Classification of Hospitals and other Health

Facilities: Hospitals and other facilities shall be classifies as
follows
Government or Private
Government Operated and maintained partially or

wholly by the national, provincial, city or municipal
government, or other political unit: or by any
department, division, board or agency thereof.36
Private
Privately
owned,
established
and
operated with funds through donation, by any

individual corporation, association or organization.
General or Special
General Provides services for all types of

deformity, disease, illness or injury.
Special Primarily engaged in the provision of

specific clinical care and management.
36
Service Capabilities
Department of Health, April 28, 2004 Philippines, Administrative Order No. 147 S. 2004

Primary Care
o Non-departmentalizes
hospital
that
provides clinical care and management

on the prevalent diseases in the facility.
o Clinical
Services
include
general
medicine, pediatrics, obstetrics, and

gynecology, surveying and anesthesia.
o Provide appropriate administrative and
ancillary services (clinical laboratory,
radiology, pharmacy)
o Provides nursing care for patients who
require
intermediate,
moderate
and
partial category of surprised care for 24

hours or longer.
Secondary Care
o Departmentalized hospital that provides
clinical care and management on the
prevalent diseases in the locality, as well
as particular forms of treatment, surgical
procedure and intensive care,37
o Clinical services provided in Primary
Care, as well as specialty clinic care.
o Provides appropriate administrative and
ancillary services (clinical, laboratory,
radiology, and pharmacy)
o Nursing care provided on primary care,
as well as total and intensive skill care.
Tertiary care
o Teaching and training hospital that
provides clinical care and management
and the prevalent diseases in the locality,
as well as specialized forms of treatment,
surgical procedure and intensive care.
o Clinical
services
provided
by
in
secondary care, as well as subspecialty

clinical care.
37
Ibid

o Provides appropriate administrative and

ancillary services (clinical laboratory,
radiology, pharmacy)
o Nursing care provided secondary care,
as
well
as
continuous
and
highly
specialized critical care.
Infirmary A health facility that

provides
emergency
treatment
and care to the sick and injured,

as well as clinical care and
management
to
mothers
and
newborn baby.
Birthing Home A health facility

that provides maternity services
on pre-natal and post-natal care,
normal spontaneous delivery, and
care of newborn baby.38
Acute Chronic Psychiatric Care

Facility A health facility that
provides
nursing
medical
care,
treatment
intervention
services,
pharmacological
and
for
psychosocial
mentally
ill
patients
Custodial Psychiatric Care Facility

A health facility that provides
long-term care, including basic
human services such as food and
shelter, to chronic mentally ill
patients.39
b. Tertiary Care Service Capability (Custodial Psychiatric Care

Facility)
i.
38
39
Service Capability
Ibid
Ibid

A hospital is classified as a Tertiary Care Hospital if it

has the appropriate Administrative, Clinical and
Nursing Services, and it has an Accredited Training
Program
for
Physicians,
Nurses
or
Medical
Technologists.
It must have Subspecialty Clinical Care under its

Clinical Service. At least one subspecialty will suffice,
and this can be any Section in any of the Departments,
e.g. Section of Cardiology in the Department of
Medicine, Section of Urology in the Department of
Surgery, etc. The Subspecialty Section must be
reflected in the organizational chart of the Clinical
Service.
Tertiary Care Hospitals shall be given until 2010 to

comply with the requirement of a Department of
Emergency Medicine.40
General Dentistry under Clinical Service may be

contracted out, but must be located within hospital
premises.
The Rehabilitation Service may be contracted out. If it

is contracted out, it may or may not be located within
hospital premises.
The organizational structure of the Nursing Service

shall provide for departments similar to those in the
Clinical Service. This must be reflected in the
organizational chart.
The Accredited Training Program may be any

Accredited Training Program for Physicians (at least
one specialty), Accredited Training Program for
Nurses, or Accredited Training Program for Medical
Technologists.
Housekeeping, Laundry and Linen, Engineering,

Security, and Dietary Services may be contracted out.
40
Department of Health, October 2004 Sta. Cruz Manila, Implementing Guidelines on the Licensure Standards for
Hospitals and Other Infirmaries for Regulatory Officers

The Ambulance Service may be contracted out, but the

ambulance must be available for 24 hours and
physically present in the hospital premises.
A Tertiary Care Hospital must have a Tertiary Clinical

Laboratory, Third Level Radiology facility, and a
Pharmacy, all of which must be licensed. These
ancillary services may be contracted out but must be
situated inside the hospital or within the hospital
complex to ensure availability and timeliness of
services.41
ii.
Personnel
Administrative Service
o The Chief of Hospital and the Administrative
Officer must have completed at least twenty (20)
units towards a Masters Degree in Hospital
Administration or a related course OR must
have at least five (5) years of experience in a
supervisory/managerial position.
The Medical Records Officer must be

trained in ICD-10.
The services of the following personnel

may be contracted out: Laundry Worker,
Utility Worker, Security Guard, Engineer,
Medical
Equipment/Biomedical
Technician, Mechanic, and Driver.
The Driver refers to the driver of the

ambulance.
There must be at least one in-house

Maintenance Personnel per shift who
shall do corrective repairs. The rest of the
Maintenance
Personnel
may
be
contracted out.
Clinical Service
o The Chief of Clinics must be a Diplomate/Fellow
of a specialty or subspecialty society AND must
41
Ibid.

have at least five (5) years of experience in a

supervisory/managerial position.
o The
Department
Head
must
be
Diplomate/Fellow of a specialty or subspecialty

society.
o There must be one Department Head for the
following Departments: Medicine, Pediatrics,
Obstetrics
and
Anesthesia,
and
Gynecology,
Emergency
Surgery,
Medicine
(if
applicable). Any additional Department must

also have its own Department Head.
o Consultant
Physicians
Diplomates/Fellows
of
must
a
specialty
be
or
subspecialty society.42
o The number of Physicians required is as follows:
o For every 100 beds and below, there must be at
least eight (8) physicians.
o For every additional 50 beds, there must be
three (3) additional physicians.
o The services of the Dentist and Dental Aide may
be contracted out.
o The services of the Physical Therapist may be
contracted out.
Nursing Service
o A Tertiary Care Hospital provides Non-Critical
Care (Level I Minimal Care and Management
and
Level
II
Intermediate
Care
and
Management) and Critical Care (Level III Intensive Care and Management and Level IV
Highly
Specialized
Critical
Care
and
Management). Thus:
o For Non-Critical Care areas, the number of Staff
Nurses
and
Nursing
Attendants/Midwives
required is the same as those of Non-Critical

Care areas in a Secondary Care Hospital.
42
Ibid.

o For Critical Care areas (ICUs, PACU/Recovery

Room), the number of Staff Nurses and Nursing
Attendants/Midwives is the same as those of
Critical Care areas in a Secondary Care
Hospital.
o The schedule of duties for Critical Care Unit
Staff Nurses and Nursing Attendants/Midwives
must be made available to Inspection Officers.
o Plantilla items for Critical Care Unit Staff Nurses
and
Nursing
Attendants/Midwives
are
optional.43
o The Chief Nurse must have a Masters Degree
in Nursing AND must have at least five (5) years
of
experience
in
nursing
supervisor/managerial position.
o For chronic care health facilities and hospitals
(e.g. Sanitaria), the number of Nurses required
is 1:24 beds, while the number of Nursing
Attendants/Midwives required is 1:18 beds.
iii.
Equipment
Although the Ambulance Service may be contracted

out, the Ambulance must be available and physically
present within the premises of the hospital for 24 hours.
The Standby Generator must have an automatic

transfer switch.
If the Rehabilitation Service is contracted out and not

located within hospital premises, all pieces of
equipment in the Rehabilitation Room are not required.
iv.
Physical Plant
The following areas are optional if the corresponding

service being provided is contracted out:
o Receiving and Releasing Area, Sorting and
Washing Area, and Pressing and Ironing Area
in the Laundry and Linen Office, if Laundry
Service is contracted out;
43
Ibid.

o Engineering Office and all the areas under it

(Maintenance Area, Housekeeping Area, Motor
pool Area), if the Engineering Service is
contracted out;
o The following areas in the dietary, if the Dietary
Service is contracted out:44
Cold and Dry Storage Area
Food Preparation Area
Cooking and Baking Area
Serving and Food Assembly Area
Washing Area
Garbage Disposal Area
Toilet
The Motor pool Area should serve as the parking area

for the Ambulance. If there is no Motor pool Area (it is
optional if the Engineering Service is contracted out),
an Ambulance Parking Area should be provided,
whether or not the Ambulance Service is contracted
out.
If the Surgical OR and Obstetrical OR/DR are in one

complex, only one male dressing room and one female
dressing room are required. Otherwise, each should
have its own dressing rooms.
If the Rehabilitation Service is contracted out and not

located within hospital premises, a Rehabilitation
Room is not required.45
c. Guidelines in the Planning and Design of a Hospital and Other

Health Facilities
A hospital and other health facilities shall be planned and

designed to observe appropriate architectural practices, to meet
prescribed functional programs, and to conform to applicable codes
as part of normal professional practice. References shall be made to
the following:
44
45
Ibid
Ibid.

P. D. 1096 National Building Code of the Philippines and

Its Implementing Rules and Regulations
P. D. 1185 Fire Code of the Philippines and Its

Implementing Rules and Regulations
P. D. 856 Code on Sanitation of the Philippines and Its

Implementing Rules and Regulations46
B. P. 344 Accessibility Law and Its Implementing Rules

and Regulations
R. A. 1378 National Plumbing Code of the Philippines

and Its Implementing Rules and Regulations
R. A. 184 Philippine Electrical Code
Manual on Technical Guidelines for Hospitals and Health

Facilities Planning and Design. Department of Health,
Manila. 1994
Signage Systems Manual for Hospitals and Offices.

Department of Health, Manila. 1994
Health Facilities Maintenance Manual. Department of

Health, Manila. 1995
Manual on Hospital Waste Management. Department of

Health, Manila. 1997
District Hospitals: Guidelines for Development. World

Health Organization Regional Publications, Western
Pacific Series. 1992
Guidelines for Construction and Equipment of Hospital

and Medical Facilities. American Institute of Architects,
Committee on Architecture for Health. 1992
De Chiara, Joseph. Time-Saver Standards for Building

Types. McGraw-Hill Book Company. 1980
Environment: A hospital and other health facilities shall be so

located that it is readily accessible to the community and
reasonably free from undue noise, smoke, dust, foul odor,
flood, and shall not be located adjacent to railroads, freight
yards, children's playgrounds, airports, industrial plants,
disposal plants.
46
Department of Health, November 2004, Guidelines in the Planning and Design of a Hospital and Other Health
Facilities

Occupancy: A building designed for other purpose shall not

be converted into a hospital. The location of a hospital shall
comply with all local zoning ordinances.47
Safety: A hospital and other health facilities shall provide and

maintain a safe environment for patients, personnel and
public. The building shall be of such construction so that no
hazards to the life and safety of patients, personnel and public
exist. It shall be capable of withstanding weight and elements
to which they may be subjected.
Exits shall be restricted to the following types: door

leading directly outside the building, interior stair, ramp,
and exterior stair.
A minimum of two (2) exits, remote from each other,

shall be provided for each floor of the building.
Exits shall terminate directly at an open space to the

outside of the building.
Security: A hospital and other health facilities shall ensure the

security of person and property within the facility.
Patient Movement: Spaces shall be wide enough for free

movement of patients, whether they are on beds, stretchers,
or wheelchairs. Circulation routes for transferring patients
from one area to another shall be available and free at all
times.
Corridors for access by patient and equipment shall

have a minimum width of 2.44 meters.
Corridors in areas not commonly used for bed,

stretcher and equipment transport may be reduced in
width to 1.83 meters.
A ramp or elevator shall be provided for ancillary,

clinical and nursing areas located on the upper floor.
A ramp shall be provided as access to the entrance of

the hospital not on the same level of the site.48
Lighting: All areas in a hospital and other health facilities shall

be provided with sufficient illumination to promote comfort,
47
48
Ibid
Ibid

healing and recovery of patients and to enable personnel in

the performance of work.
Ventilation: Adequate ventilation shall be provided to ensure

comfort of patients, personnel and public.
Auditory and Visual Privacy: A hospital and other health

facilities shall observe acceptable sound level and adequate
visual seclusion to achieve the acoustical and privacy
requirements in designated areas allowing the unhampered
conduct of activities.
Water Supply: A hospital and other health facilities shall use

an approved public water supply system whenever available.
The water supply shall be potable, safe for drinking and
adequate, and shall be brought into the building free of cross
connections.
Waste Disposal: Liquid waste shall be discharged into an

approved public sewerage system whenever available, and
solid waste shall be collected, treated and disposed of in
accordance with applicable codes, laws or ordinances.
Sanitation: Utilities for the maintenance of sanitary system,

including approved water supply and sewerage system, shall
be provided through the buildings and premises to ensure a
clean and healthy environment.
Housekeeping: A hospital and other health facilities shall

provide and maintain a healthy and aesthetic environment for
patients, personnel and public.
Maintenance:
There
shall
be
an
effective
building
maintenance program in place. The buildings and equipment

shall be kept in a state of good repair. Proper maintenance
shall be provided to prevent untimely breakdown of buildings
and equipment.
Material Specification: Floors, walls and ceilings shall be of

sturdy materials that shall allow durability, ease of cleaning
and fire resistance.49
Segregation: Wards shall observe segregation of sexes.

Separate toilet shall be maintained for patients and personnel,
49
Ibid

male and female, with a ratio of one (1) toilet for every eight
(8) patients or personnel.
Fire Protection: There shall be measures for detecting fire

such as fire alarms in walls, peepholes in doors or smoke
detectors in ceilings. There shall be devices for quenching fire
such as fire extinguishers or fire hoses that are easily visible
and accessible in strategic areas.
Signage. There shall be an effective graphic system

composed of a number of individual visual aids and devices
arranged to provide information, orientation, direction,
identification,
prohibition,
warning
and
official
notice
considered essential to the optimum operation of a hospital

and other health facilities.
Parking. A hospital and other health facilities shall provide a

minimum of one (1) parking space for every twenty-five (25)
beds.
Zoning: The different areas of a hospital shall be grouped

according to zones as follows:
Outer Zone areas that are immediately accessible to

the public: emergency service, outpatient service, and
administrative service. They shall be located near the
entrance of the hospital.
Second Zone areas that receive workload from the

outer zone: laboratory, pharmacy, and radiology. They
shall be located near the outer zone.
Inner Zone areas that provide nursing care and

management of patients: nursing service. They shall
be located in private areas but accessible to guests.50
Deep Zone areas that require asepsis to perform the

prescribed services: surgical service, delivery service,
nursery, and intensive care. They shall be segregated
from the public areas but accessible to the outer,
second and inner zones.
Service Zone areas that provide support to hospital

activities: dietary service, housekeeping service,
50
Ibid

maintenance and motor pool service, and mortuary.

They shall be located in areas away from normal traffic.
Function: The different areas of a hospital shall be functionally

related with each other.
The emergency service shall be located in the ground

floor to ensure immediate access. A separate entrance
to the emergency room shall be provided.
The administrative service, particularly admitting office

and business office, shall be located near the main
entrance
of
the
hospital.
Offices
for
hospital
management can be located in private areas.
The surgical service shall be located and arranged to

prevent non-related traffic. The operating room shall be
as remote as practicable from the entrance to provide
asepsis. The dressing room shall be located to avoid
exposure to dirty areas after changing to surgical
garments. The nurse station shall be located to permit
visual observation of patient movement.51
The delivery service shall be located and arranged to

prevent non-related traffic. The delivery room shall be
as remote as practicable from the entrance to provide
asepsis. The dressing room shall be located to avoid
exposure to dirty areas after changing to surgical
garments. The nurse station shall be located to permit
visual observation of patient movement. The nursery
shall be separate but immediately accessible from the
delivery room.
The nursing service shall be segregated from public

areas. The nurse station shall be located to permit
visual observation of patients. Nurse stations shall be
provided in all inpatient units of the hospital with a ratio
of at least one (1) nurse station for every thirty-five (35)
beds. Rooms and wards shall be of sufficient size to
allow for work flow and patient movement. Toilets shall
be immediately accessible from rooms and wards.
51
Ibid

The dietary service shall be away from morgue with at

least 25-meter distance.
Space: Adequate area shall be provided for the people,

activity, furniture, equipment and utility.52
d. Licensing Requirements for Custodial Psychiatric Care

Facility
i.
ii.
Service Capability
General Administrative Service
Custodial Service
Group Psychotherapy
Occupational Therapy
Recreational Therapy
Nursing Care
Dietary53
Personnel
Number
of
Personnel
iii.
Administrator
Clerk
Laundry Worker
Utility Worker
Security Aids
Medical social worker
1:100
Custodial Service
Psychiatrist (on call)
Psychologist (on call)
Nurse
1:20
Nursing Attendant
1:10/shift
Cook
Equipment/Instrument
Number
of
Equipment
52
53
Bench
Cabinet
Ibid
Department of Health, April 28, 2004 Philippines, Administrative Order No. 147 S. 2004

iv.
Calculator
Chair
Desk
Fire Extinguisher
Standby Generator
Transport Vehicle
Typewriter
Custodial Service
Bed with Strap
Clinical Weighing Scale
Sphygmomanometer
Stethoscope
Basketball
Guitar
Karaoke
Table tennis
Television
VHS
Conveyor
Dish Storage
Electric Fan
Exhaust Fan
Food Scale
Osterizer/blender
Refrigerator/Freezer
Storage Rack/Shelf
Stove
Utility Cart
Work Table
Depending on ABC
Physical Plant
Waiting Area
Information and Receiving Area
Business Office
Staff Toilet
Custodial Service
Nursing Unit
Female Ward with Toilet


Male Ward with Toilet
Isolation Room with Toilet
Nurse Station with Work Area and

Lavatory Sink
Occupational and Recreational Unit
Indoor Activity Area
Outdoor Activity Area
Dietary
Cold and Dry Storage Area
Food Preparation Area
Cooking and Baking Area
Washing Area
Garbage Disposal Area
Dining Room54
e. National Building Code of the Philippines

CLASSIFICATION AND GENERAL REQUIREMENT OF ALL
BUILDINGS BY USE OR OCCUPANCY
SECTION 701. Occupancy Classified
(4)Group D Institutional
Group D Occupancies shall include:
Division 1 - Mental hospitals, mental sanitaria, jails,
prisons, reformatories, and buildings where personal liberties
of inmates are similarly restrained.
Division 2 - Nurseries for full-time care of children under
kindergarten age, hospitals, sanitaria, nursing homes with nonambulatory
patients,
and
similar
buildings
each
accommodating more than five persons.

Division 3 - Nursing homes for ambulatory patients,
homes for children of kindergarten age or over, each
accommodating more than five persons: Provided, that Group
54
Ibid.

D Occupancies shall not include buildings used only for private

or family group dwelling purposes.55
The National Building Code
Parking Space Guideline
for Nursing Homes
Specific Uses or of
Reference Uses or Character
Minimum Required. Parking
Occupancy (refer to
of Occupancies or Type of
Slot. Parking Area and
Section.1 .3 of this Rule)
Building Structures
Loading Space Requirements
Private hospital
One ( 1 ) off-street cum onsite

car parking slot for every
twelve ( 12) beds; and one (1)
off RROW (or off-street)
passenger loading space that
can accommodate two (2)
queued jeepney/shuttle slots;
provide at least one (12)
loading slot for articulated
truck or vehicle (a 12.00
meters long container van
plus 6.00 meters length for a
long/hooded prime mover)
and one ( 1) loading slot for a
standard truck for every
5,000.00 sq. meters of GFA;
and provide truck
maneuvering area outside of
the RROW (within property or
lot lines only)
4.3. Division D-3
Nursing homes for
One ( 1) off-street cum onsite
ambulatory patients. School
car parking slot for every
and home, for children over
twelve (12) beds; and one (1)
kindergarten age,
off-RROW (or off-street}
orphanages and the like
passenger loading space that

can accommodate two (2)
queued jeepney/shuttle slots
National Building Code Unit

Area (sq. meters)
Requirement
55
Vicente B. Foz, 2007, Metro Manna, Philippines, The National Building Code of the Philippines and its Revised
Implementing Rules and Regulations

Minimum of Two (2) Exits

Use or Occupancy
Unit Area per Occupant (sq.
Other than Elevators are
meters)
Required Where Number of

Occupants is Over
Dwellings
28.00
10
Hostels
18.60
10
Apartment
18.60
10
Dormitories
18.60
10
Classrooms
1.80
50
Conference rooms
1.40
50
Exhibit rooms
1.40
50
Gymnasia
1.40
50
School shops
4.60
50
Vocational institutions
4.60
50
Laboratories
4.60
50
Hospitals**, Sanitaria**
8.40
Nursing Homes**
7.40
Children Homes**
7.40
Homes for the Aged**
7.40
3.25
(**Institutional sleeping
departments shall be based
on one (1) occupant per
11.00 sq. meter of the gross
floor area, In-patient
Institutional Treatment
Department shall be based in
one (1) occupant per 22.00
sq. meters of gross floor
area)
Nurseries for Children

A. Case Study And Theories

1. Mental Health Theorist
Hildegard Peplau
In 1952, Hildegard Peplaus publication, Interpersonal
Relations in Nursing: A Conceptual Framework for Psychodynamic

Nursing, influenced nursing practice (see earlier discussions of
Peplaus contribution to psychiatric nursing). The foundation of her
theory came from Harry Stack Sullivans postulates. Her concepts
and perspectives were developed into nursing theory, which became
the basis of interpersonal processes in nursing. These were related
to the promotion of healthy adaptation to life stressors.
June Mellow and Gwen Tudor56

Other theorists during the 1950s included June Mellow, who
developed concepts in nursing theory that were based on work with

clients suffering from schizophrenia. She stressed the influence of
the nurse-client relationship and the nursing process on client
outcomes. Furthermore, Gwen Tudor (1952) defined psychiatric
nursing as an interpersonal process of observation, intervention, and
evaluation. Tudor described three major functions of the nurse: as a
facilitator of communication, social interaction, and self-care.
Additionally, she stressed the significance of social context and its
impact on the nurses attitude and response to their clients needs
and subsequent mental health. Contributions from these nurses
were instrumental in legitimizing the role of psychiatric nursing and
establishing the foundation for current therapeutic interventions.
Adolph Meyer (18661950)

In 1902, Adolph Meyer, a psychiatrist from Sweden, initiated
the psychobiological theory and dynamic concept of psychiatric care.

He focused on physical and emotional maturational changes. He
emphasized the need to study the persons whole environment to
determine its effects on the total personality. His psychobiological
theory centered on treatment rather than disease and integrated
biochemical, genetic, psychosocial, and environmental stresses on
56
Deborah Antai-Otong, MS, APRN, BC, FAAN, 2008, Psychiatric Nursing Biological and Behavioral Concept

mental illness. He accepted the concept that mental disease resulted

from the individuals mal- adaptation to his/her environment. Meyer
introduced the concept of commonsense psychiatry, which was
based on ways that clients could realistically improve life situations
(Lewis, 1974).
Emil Kraepelin (18561926)

Emil Kraepelin, a noted psychiatrist from Munich, devised a
classification of mental disorders, which gave momentum to the

advancement of psychiatry. His work shifted from an emphasis on
research in the pathobiological laboratory to the observation and
research in conditions known as praecox dementia and mania.
Eugen Bleuler (18571939)

At the end of the century, Eugen Bleuler, one of Kraepelins
students, coined the term schizophrenia and included among its

characteristics the four as: apathy, associative looseness, autism,
and ambivalence. His noted treatise, Dementia Praecox or Group of
Schizophrenias, delineated the complexity of schizophrenia.
Sigmund Freud (18561939)

During this period, a Viennese neurologist named Sigmund
Freud was credited with the development of psychoanalysis,

psychosexual theories, and neurosis. He revolutionized psychiatry
through his use of psychoanalysis, a method that serves as the basis
for treatment and a theory for personality development. He
popularized
explanations
the
for
term
catharsis,
hysteria.
His
dream
interpretations,
contributions
stimulated
and
the
development and rationale for research and established the basis of

modern psychoanalytical technique. This technique focused on
increasing awareness of the unconscious aspects of the clients
personality57
2. Mental Health Theories
57
Modeling and Role Modeling Theory
Ibid

The Modeling and Role Modeling Theory was developed by

Helen Erickson, Evelyn M. Tomlin, and Mary Anne P. Swain. It was
first published in 1983 in their book Modeling and Role Modeling: A
Theory and Paradigm for Nursing. The theory enables nurses to care
for and nurture each patient with an awareness of and respect for the
individual patient's uniqueness. This exemplifies theory-based clinical
practice that focuses on the patient's needs.
The theory draws concepts from a variety of sources. Included
in the sources are Maslow's Theory of Hierarchy of Needs, Erikson's
Theory of Psychosocial Stages, Piaget's Theory of Cognitive
Development, and Seyle and Lazarus's General Adaptation
Syndrome.
In the theory, modeling is the process by which the nurse seeks
to know and understand the patient's personal model of his or her own
world, as well as learns to appreciate its value and significance.
Modeling recognizes that each patient has a unique perspective of his
or her own world. These perspectives are called models. The nurse
uses the process to develop an image and understanding of the
patient's world from that patient's unique perspective.
Role modeling is the process by which the nurse facilitates and
nurtures the individual in attaining, maintaining, and promoting health.
It accepts the patient as he or she is unconditionally, and allows the
planning of unique interventions. According to this concept, the
patient is the expert in his or her own care, and knows best how he or
she needs to be helped.58
This model gives the nurse three main roles. They are
facilitation, nurturance, and unconditional acceptance. As a facilitator,
the nurse helps the patient take steps toward health, including
providing necessary resources and information. As a nurturer, the
nurse provides care and comfort to the patient. In unconditional
acceptance, the nurse accepts each patient just as he or she is
without any conditions.
The basic theoretical linkages used in nursing practice for this
model are: developmental task resolution (residual) and need
58
Retrieved from http://www.nursing-theory.org/theories-and-models , date retrieved August 2, 2014


satisfaction are related; basic need status, object attachment and

loss, growth and development are all interrelated; and adaptive
potential and need status are related.
According to the theory, the five goals of nursing intervention
are to build trust, promote the patient's positive orientation, promote
the patient's control, affirm and promote the patient's strengths, and
set mutual, health-directed goals.
Modeling refers to the development of an understanding of the
patient's world, while role modeling is the nursing intervention, or
nurturance, that requires unconditional acceptance. This model
considers nursing as a self-care model based on the patient's
perception of the world, as well as his or her adaptation to stressors.59
When it comes to research, the following are some theoretical
propositions presented by the model:
The individual's ability to contend with new stressors is

directly related to the ability to mobilize resources needed.
The individual's ability to mobilize resources is directly

related to their need deficits and assets.
Distressors are unmet basic needs; stressors are unmet

growth.
Objects that repeatedly facilitate the individual patient in

need take on significance for that individual patient. When
this occurs, attachment to the significant object occurs.
Secure attachment produces feelings of worthiness.
Feelings of worthiness result in a sense of futurity.
Real, threatened, or perceived loss of the attachment

object results in morbid grief.
Basic need deficits co-exist with the grief process.
An adequate alternative object must be perceived as

available in order for the patient to resolve his or her grief
process.
Prolonged grief due to an unavailable or inadequate object

results in morbid grief.
Unmet basic and growth needs interfere with growth

processes for the patient.
59
Ibid.

Repeated satisfaction of basic needs is a prerequisite to

working through developmental tasks and resolution of
related developmental crises.
Morbid grief is always related to need deficits.60
Goal Attainment
The Theory of Goal Attainment was developed by Imogene
King in the early 1960s. It describes a dynamic, interpersonal

relationship in which a patient grows and develops to attain certain
life goals. The theory explains that factors which can affect the
attainment of goals are roles, stress, space, and time.
The model has three
interacting systems:
personal,
interpersonal, and social. Each of these systems has its own set of
concepts. The concepts for the personal system are perception, self,
growth and development, body image, space, and time. The
concepts
for
the
interpersonal
system
are
interaction,
communication, transaction, role, and stress. The concepts for the

social system are organization, authority, power, status, and
decision-making.
The Theory of Goal Attainment was developed by Imogene
King in the early 1960s. It describes a dynamic, interpersonal
relationship in which a patient grows and develops to attain certain
life goals. The theory explains that factors which can affect the
attainment of goals are roles, stress, space, and time.
The model has three
interacting systems:
personal,
interpersonal, and social. Each of these systems has its own set of
concepts. The concepts for the personal system are perception, self,
growth and development, body image, space, and time. The
concepts
for
the
interpersonal
system
are
interaction,
communication, transaction, role, and stress. The concepts for the

social system are organization, authority, power, status, and
decision-making.
The following propositions are made in the Theory of Goal
Attainment:
60
Ibid

If perceptual interaction accuracy is present in nurse-patient

interactions, transaction will occur.
If the nurse and patient make transaction, the goal or goals will
be achieved.
If the goal or goals are achieved, satisfaction will occur.
If transactions are made in nurse-patient interactions, growth and

development will be enhanced.61
If role expectations and role performance as perceived by the

nurse and patient are congruent, transaction will occur.
If role conflict is experienced by either the nurse or the patient (or

both), stress in the nurse-patient interaction will occur.
If a nurse with special knowledge communicates appropriate

information to the patient, mutual goal-setting and goal
achievement will occur.
There are also assumptions made in the model. They are:
The focus of nursing is the care of the human being (patient).
The goal of nursing is the health care of both individuals and

groups.
Human beings are open systems interacting with their

environments constantly.
The nurse and patient communicate information, set goals

mutually, and then act to achieve those goals. This is also the
basic assumption of the nursing process.
Patients perceive the world as a complete person making

transactions with individuals and things in the environment.
Transaction represents a life situation in which the perceiver and

the thing being perceived are encountered. It also represents a
life situation in which a person enters the situation as an active
participant. Each is changed in the process of these experiences.
According to King, a human being refers to a social being who
is rational and sentient. He or she has the ability to perceive, think,

feel, choose, set goals, select means to achieve goals, and make
decisions. He or she has three fundamental needs: the need for
health information when it is needed and can be used; the need for
61
Ibid

care that seeks to prevent illness; and the need for care when he or
she is unable to help him or herself.62
B. Safety And Security

1. Safety Measures
a. Accessibility Law (B.P. 344)
i.
Rule II Minimum Requirement for Accessibility

1. Design Criteria:
1.1 CATEGORIES OF DISABLED PERSONS. The
categories of disability dictate the varied measures to be
adopted in order to create an accessible environment for the
handicapped. Disabled persons under these Rules may be
classified into those who have:
1.1.1
Impairments
requiring
confinement
to
wheelchairs; or
1.1.2 Impairments causing difficulty or insecurity in
walking or climbing stairs or requiring the use of
braces, crutches or other artificial supports; or
impairments caused by amputation, arthritis, spastic
conditions or pulmonary, cardiac or other ills rendering
individuals semi-ambulatory; or
1.1.3 Total or partial impairments of hearing or sight
causing insecurity or likelihood of exposure to danger
in public places; or
1.1.4 Impairments due to conditions of aging and
incoordination;
1.1.5
Mental
impairments
whether
acquired
or
congenital in nature.63
62
63
Ibid
Department of Public Works and Highway, March 2012, The law to Enhance Mobility of Disabled Persons (BP 344)

1.2
ANTHROPOMETRICS
AND
DIMENSIONAL
DATA AS GUIDES FOR DESIGN. The minimum and

maximum dimensions for spaces in the built environment
should consider the following criteria:
1.2.1 The varying sizes and structures of persons of
both sexes, their reaches and their lines of sight at both
the standing and sitting positions.
1.2.2 The dimensional data of the technical aids of
disabled persons.
Included
in
the
second
consideration
are
the
dimensions of wheelchairs; the minimum space

needed for locking and unlocking leg braces plus the
range of distance of crutches and other walking aids
from persons using such devices.
By applying at this very early stage dimensional criteria
which take into account wheelchair usage, the physical
environment will ultimately encourage and enable
wheelchair users to make full use of their physical
surroundings.
1.2.3 The provision of adequate space for wheelchair
maneuvering generally insures adequate space for
disabled persons equipped with other technical aids or
accompanied by assistants. In determining the
minimum
accessible
dimensions
to
for
disabled
furniture
persons,
and
the
fixtures
following
anthropometric data shall serve as guides for design:

The length of wheelchairs varies from 1.10 m to 1.30
m.64
The width of wheelchairs is from 0.60 m to 0.75 m.
A circle of 1.50 m in diameter is a suitable guide in the
planning of wheelchair turning spaces.
The comfortable reach of persons confined to
wheelchairs is from 0.70 m to 1.20 m above the floor
64
Ibid

andnot less than 0.40 m from room corners. The

comfortable clearance for knee and leg space under
tables for wheelchair users is 0.70 m.
Counter height shall be placed at a level comfortable
to disabled persons' reach.
[Refer to Annex B-2 to B-6, Figs. 2 to 8.]
1.3 BASIC PHYSICAL PLANNING REQUIREMENTS.
No group of people shall be deprived of full participation and
enjoyment of the environment or be made unequal with the
rest due to any disability. In order to achieve this goal adopted
by the United Nations, certain basic principles shall be
applied:
1.3.1 ACCESSIBILITY. The built environment shall be
designed so that it shall be accessible to all people.
This means that no criteria shall impede the use of
facilities by either the handicapped or non-disabled
citizens.
1.3.2 REACHABILITY. Provisions shall be adapted
and introduced to the physical environment so that as
many places or buildings as possible can be reached
by all.65
1.3.3 USABILITY. The built environment shall be
designed so that all persons, whether they be disabled
or not, may use and enjoy it.
1.3.4 ORIENTATION. Finding a person's way inside
and outside of a building or open space shall be made
easy for everyone.
1.3.5 SAFETY. Designing for safety insures that
people shall be able to move about with less hazards
to life and health.
1.3.6 WORKABILITY AND EFFICIENCY. The built
environment shall be designed to allow the disabled
65
Ibid

citizens to participate and contribute to developmental

goals.
ii.
Rule III Specific Requirements for Buildings and Related

Structures for Public Use
1. Classification of building by use of occupancy:

1.1 Occupancy classified by categories enumerated in
Section 701 of the National Building Code (PD 1096) are hereby
adapted.
1.1.1 Category I - Residential -This shall comprise
Group A and partly Group B Buildings
1.1.2 Category II - Commercial and Industrial -This
shall comprise partly Groups B, C, E, F, G, H, and I Buildings66
1.1.3 Category III - Educational and Industrial - This
shall comprise partly Group C, D, E, and H Buildings
1.1.4 Category IV - Agricultural - This shall comprise
partly Group J Buildings.
1.1.5 Category V - Ancillary - This shall comprise partly
Group J Buildings
Note: The foregoing categories are consistent with those
found in Presidential Decree (P.D.) No. 1096, otherwise known as
the 1977 National Building Code of the Philippines (NBCP) and its
2004 Revised IRR, which are implemented/ enforced by the
Department of Public Works and Highways (DPWH).
2. Architectural features and facilities:
Where the following features and facilities are: architectural
design requirements in accordance with generally accepted
architectural practice, the same include the corresponding graphic
signs.
2.1 Architectural facilities and features:
66
Ibid.

2.1.1 A - Stairs
2.1.2 B - Walkways
2.1.3 C - Corridors
2.1.4 D - Doors and Entrances
2.1.5 E - Washrooms and Toilets
2.1.6 F - Lifts/Elevators
2.1.7 G - Ramps
2.1.8 H - Parking Areas
2.1.9 I - Switches, Controls, Buzzers
2.1.10 J - Handrails
2.1.12 K - Thresholds
2.1.12 L - Floor Finishes
2.1.13 M - Drinking Fountains
2.1.14 N - Public Telephones
2.1.15 O - Seating Accommodations
iii.
Category III
5.3 Group D-2

5.3.1 Homes for the Aged Barrier-free facilities and
features required in: A, B, C, D, E, G, H, I, J, K, L, and
M.
5.3.2 Hospitals and Sanitaria Barrier-free facilities and
features required in: A, B, C, D, E, G, H, I, J, K, L, and
M.
5.4 Group D-3
5.4.1 Nursing Homes for ambulatory patients Barrierfree facilities and features required in: A, B, C, D, E, G,
H, I, J, K, L, and M.

5.4.2 Orphanages Barrier-free facilities and features

required in: A, B, C, D, E, G, H, I, J, K, L, and M.67
iv.
Minimum Requirements for Accessibility Illustrations for

Minimum Requirements
OUTSIDE AND AROUND BUILDINGS

1. DROPPED CURBS
1.1 Changes in level walkways should be by a dropped
curb.
1.2 Dropped curbs should be provided at pedestrian
crossings and at the end of walkways of a private street
or access road.
1.3 Dropped curbs at crossings have a width
corresponding to the width of the crossing; otherwise,
the minimum width is 0.90 m.
1.4 Dropped curbs shall be ramped towards adjoining
curbs with a gradient not more than 1:12.
1.5 Dropped curbs shall be sloped towards the road
with a maximum cross gradient of 1:20 to prevent water
from collecting at the walkway.
1.6 The lowest point of a dropped curb should not
exceed 25 mm from the road or gutter.
2. CURB CUT-OUTS
2.1 Curb cut-outs should only be allowed when it will
not obstruct a walkway or in any way lessen the width
of a walkway.
2.2 The minimum width of a curb cut-out should be 0.90
M.
67
Ibid.

2.3 Curb cut-outs should have a gradient not more than

1:12.
3. WALKWAYS AND PASSAGEWAYS
3.1 Walkways should be kept as level as possible and
provided with slip-resistant material.
3.2 Whenever and wherever possible, walkways 3.3
Walkways should have a maximum cross gradient of
1:100.
3.4 Walkways should have a minimum width of 1.20
meters.
3.5 If possible, gratings should never be located along
walkways.
When occurring along walkways, grating openings
should have a maximum dimension of 13 mm x 13 mm
and shall not project more than 6.5 mm above the level
of the walkway.
3.6 Walkways should have a continuing surface
without abrupt pitches in angle or interruptions by
cracks or breaks creating edges above 6.50 mm.
3.7 In lengthy or busy walkways, spaces should be
provided at some point along the route so that a
wheelchair may pass another or turn around. These
spaces should have a minimum dimension of 1.50 m
and should be spaced at a maximum distance of 12:00
m between stops.
3.8 To guide the blind, walkways should as much as
possible follow straightforward routes with right angle
turns.
3.9 Where planting is provided adjacent to the
walkway, regular maintenance is essential to ensure
branches of trees or shrubs do not overhang walkways
or paths, as not only do these present a particular
danger to the blind, but they also reduce the effective
footways width available to pedestrians generally.

3.10 Walkway headroom should not be less than 2.0 m

and preferably higher.
3.11 Passageways for the disabled should not be
obstructed by street furniture, bollards, sign posts or
columns along the defined route, as they can be
hazardous.
4. HANDRAILS
4.1 Handrails should be installed at both sides of ramps
and stairs and at the outer edges of dropped curbs.
Handrails at dropped curbs should not be installed
beyond the width of any crossing so as not to obstruct
pedestrian flow.
4.2 Handrails shall be installed at 0.90 m and 0.70 m
above steps or ramps. Handrails for protection at great
heights may be installed at 1.0 m to 1.06 m.
4.3 A 0.30 m long extension of the handrail should be
provided at the start and end of ramps and stairs.
4.4 Handrails that require full grip should have a
dimension of 30 mm to 50 mm.
4.5 Handrails attached to walls should have a
clearance no less than 50 mm from the wall. Handrails
on ledges should have a clearance not less than 40
mm.
5. OPEN SPACES
5.1 Where open spaces are provided, the blind can
become particularly disoriented. Therefore, it is
extremely helpful if any walkway or paths can be given
defined edges either by the use of planters with dwarf
walls, or a grass verge, or similar, which provides a
texture different from the path.
6. SIGNAGES

6.1 Directional and informational sign should be

located at points conveniently seen even by a person
on a wheelchair and those with visual impairments;
6.2 Signs should be kept simple and easy to
understand; signages should be made of contrasting
colors and contrasting gray matter to make detection
and reading easy;
6.3 The international symbol for access should be used
to designate routes and facilities that are accessible;
6.4 Should a sign protrude into a walkway or route, a
minimum headroom of 2.0 meters should be provided;
6.5 Signs on walls and doors should be located at a
maximum height of 1.60 M. and a minimum height of
1.40 meters. For signage on washroom doors, see C.
Section 8.6.
6.6 Signages labelling public rooms and places should
have raised symbols, letters or numbers with minimum
height of 1 mm; braille symbols should be included in
signs indicating public places and safety routes;
6.7 Text on signboards shall be of a dimension that
people with less than normal visual acuity can read at
a certain distance.should have a gradient no more than
1:20 or 5%.
7. CROSSINGS
7.1 In order to reduce the exposure time to vehicular
traffic, all at grade crossing should
7.1.1 Be as near perpendicular to the carriageway as
possible.
7.1.2 Be located at the narrowest, most convenient part
of the carriageway.
7.1.3 Have central refuges of at least 1.5 m in depth
and preferably 2 m, provided as a midcrossing shelter,

where the width of carriageway to be crossed exceeds

10 m.
7.2 All crossings should be located close if not
contiguous with the normal pedestrian desire line.
7.3 Provide tactile blocks in the immediate vicinity of
crossings as an aid to the blind. The tactile surface has
to be sufficiently high enough to be felt through the sole
of the shoe but low enough not to cause pedestrian to
trip, or to effect the mobility of wheelchair users. See
details of recommended pairing slabs below.
Note: Tactile strips formed from brushed or grooved
concrete finishes have not been proven successful as
they do not provide sufficient distinction from the
normal footway surface and therefore should not be
used.
7.4 The most beneficial form of crossing as far as any
disabled are concerned is the light controlled crossing
having pedestrian phases and synchronized audible
signals and should, wherever possible, be provided in
preference to other types of crossings as determined
by the duly authorized agency.
7.5 The audible signal used for crossings should be
easily distinguishable from other sounds in the
environment to prevent confusion to the blind. A
prolonged sound should be audible to warn the blind
that the lights are about to change. (Design of such a
system shall be developed by the Traffic Engineering
Center.)
7.6 The flashing green period required for the disabled
should be determined on the basis of a walking speed
of 0.90 m/sec. rather than 1.20 m/sec. which is what is
normally used. The minimum period for the steady
green (for pedestrians) should not be less than 6
seconds or the crossing distance times 0.90 m/sec.,
whichever is the greatest.

PARKING
1. PARKING AREAS
1.1 Parking spaces for the disabled should allow
enough space for a person to transfer to a wheelchair
from a vehicle;
1.2 Accessible parking spaces should be located as
close as possible to building entrances or to accessible
entrances;
1.3 Whenever and wherever possible, accessible
parking spaces should be perpendicular or to an angle
to the road or circulation aisles;
1.4 Accessible parking slots should have a minimum
width of 3.70 m.;
1.5 A walkway from accessible spaces of 1.20 m. clear
width shall be provided between the front ends of
parked cars;
1.6 Provide dropped curbs or curb cut-outs to the
parking level where access walkways are raised;
1.7 Pavement markings, signs or other means shall be
provided
to
delineate
parking
spaces
for
the
handicapped;
1.8 Parking spaces for the disabled should never be
located at ramped or sloping areas;
INSIDE BUILDINGS AND STRUCTURES

1. ENTRANCES
1.1 Entrances should be accessible from arrival and
departure points to the interior lobby;
1.2 One (1) entrance level should be provided where
elevators are accessible;
1.3 In case entrances are not on the same level of the
site arrival grade, ramps should be provided as access
to the entrance level;

1.4 Entrances with vestibules shall be provided a level

area with at least a 1.80 m. depth and a 1.50 m. width;
2. RAMPS
2.2 Changes in level require a ramp except when
served by a dropped curb, an elevator or other
mechanical device;
2.2 Ramps shall have a minimum clear width of 1.20
m;
2.3 The maximum gradient shall be 1:12;
2.4 The length of a ramp should not exceed 6:00 m. if
the gradient is 1:12; longer ramps whose gradient is
1:12 shall be provided with landings not less than 1.50
m.;
2.5 A level area not less than 1.80 m. should be
provided at the top and bottom of any ramp;
2.6 Handrails will be provided on both sides of the ramp
at 0.70 m. and 0.90 m. from the ramp level;
2.7 Ramps shall be equipped with curbs on both sides
with a minimum height of 0.10 m.;
2.8 Any ramp with a rise greater than 0.20 m. and leads
down towards an area where vehicular traffic is
possible, should have a railing across the full width of
its lower end, not less than 1.80 meters from the foot
of the ramp;
3. DOORS
3.1 All doors shall have a minimum clear width of 0.80
m;
3.2 Clear openings shall be measured between the
surface of the fully open door at the hinge and the door
jamb at the stop;
3.3 Doors should be operable by a pressure or force
not more than 4.0 kg; the closing device pressure an
interior door shall not exceed 1 kg.;

3.4 A minimum clear level space of 1.50 m x 1.50 m

shall be provided before and extending beyond a door;
EXCEPTION: where a door shall open onto but not into
a corridor, the required clear, level space on the
corridor side of the door may be a minimum of 1.20 m.
corridor width;
3.5 Protection should be provided from doors that
swing into corridors;
3.6 Outswinging doors should be provided at storage
rooms, closets and accessible restroom stalls;
3.7 Latching or non-latching hardware should not
require wrist action or fine finger manipulation;
3.8 Doorknobs and other hardware should be located
between 0.82 m. and 1.06 m. above the floor; 0.90 is
preferred;
3.9 Vertical pull handles, centered at 1.06 m. above the
floor, are preferred to horizontal pull bars for swing
doors or doors with locking devices;
3.10 Doors along major circulation routes should be
provided with kick plates made of durable materials at
a height of 0.30 m. to 0.40 m;
4. THRESHOLDS
4.1 Thresholds shall be kept to a minimum; whenever
necessary, thresholds and sliding door tracks shall
have a maximum height of 25 mm and preferably
ramped;
5. SWITCHES
5.1 Manual switches shall be positioned within 1.20 m
to 1.30 m above the floor;
5.2 Manual switches should be located no further than
0.20 from the latch side of the door;
6. SIGNAGES

(See "SIGNAGES" under OUTSIDE & AROUND

BUILDINGS.)
7. CORRIDORS
7.1 Corridors shall have minimum clear width of 1.20
m.; waiting areas and other facilities or spaces shall not
obstruct the minimum clearance requirement;
7.2 Recesses or turnabout spaces should be provided
for wheelchairs to turn around or to enable another
wheelchair to pass; these spaces shall have a
minimum area of 1.50 m x 1.50 m. and shall be spaced
at a maximum of 12.00 m.;
7.3 Turnabout spaces should also be provided at or
within 3.50 m. of every dead end;
7.4 As in walkways, corridors should be maintained
level and provided with a slip resistant surface;
8. WASHROOMS & TOILETS
8.1. Accessible public washrooms and toilets shall
permit easy passage of a wheelchair and allow the
occupant to enter a stall, close the door and transfer to
the water closet from either a frontal or lateral position;
8.2 Accessible water closet stalls shall have a
minimum area of 1.70 x 1.80 mts. One movable grab
bar and one fixed to the adjacent wall shall be installed
at the accessible water closet stall for lateral mounting;
fixed grab bars on both sides of the wall shall be
installed for stalls for frontal mounting;
8.3 A turning space of 2.25 sq.m. with a minimum
dimension of 1.50 m. for wheelchair shall be provided
for water closet stalls for lateral mounting;
8.4 All accessible public toilets shall have accessories
such as mirrors, paper dispensers, towel racks and
fittings such as faucets mounted at heights reachable
by a person in a wheelchair;

8.5 The minimum number of accessible water closets

on each floor level or on that part of a floor level
accessible to the disabled shall be one (1) where the
total number of water closets per set on that level is 20;
and two (2) where the number of water closets exceed
20;
8.6 In order to aid visually impaired persons to readily
determine whether a washroom is for men or for
women, the signage for men's washroom door shall be
an equilateral triangle with a vertex pointing upward,
and those for women shall be a circle; the edges of the
triangle should be 0.30 m long as should be the
diameter of the circle; these signages should at least
be 7.5 mm thick; the color and gray value of the doors;
the words "men" and "women" or the appropriate stick
figures should still appear on the washroom doors for
the convenience of the fully sighted;
Note: the totally blind could touch the edge of the signs
and easily determine whether it is straight or curved;
8.7 The maximum height of water closets should be
0.45 m.; flush control should have a maximum height
of 1.20 mts.
8.8 Maximum height of lavatories should be 0.80 m.
with a knee recess of 0.60 - 0.70 M. vertical clearance
and a 0.50 m. depth.
8.9 Urinals should have an elongated lip or through
type; the maximum height of the lip should be 0.48 m.
9. STAIRS
9.1 Tread surfaces should be a slip-resistant material;
nosings may be provided with slip-resistant strips to
further minimize slipping:
9.2 Slanted nosings are preferred to projecting nosings
so as not to pose difficulty for people using crutches or
braces whose feet have a tendency to get caught in the

recessed space or projecting nosings. For the same

reason, open stringers should be avoided.
9.3 The leading edge of each step on both runner and
riser should be marked with a paint or non-skid material
that has a color and gray value which is in high contrast
to the gray value of the rest of the stairs; markings of
this sort would be helpful to the visually impaired as
well as to the fully sighted person;
9.4 A tactile strip 0.30 m. wide shall be installed before
hazardous areas such as sudden changes in floor
levels and at the top and bottom of stairs; special care
must be taken to ensure the proper mounting or
adhesion of tactile strips so as not to cause accidents;
10. ELEVATORS
10.1 Accessible elevators should be located not more
than 30.00 m. from the entrance and should be easy to
locate with the aid of signs;
10.2 Accessible elevators shall have a minimum
dimension of 1.10 m. x 1.40 m.;
10.3 Control panels and emergency system of
accessible elevators shall be within reach of a seated
person; centerline heights for the topmost buttons shall
be between 0.90 m to 1.20 m from the floor;
10.4 Button controls shall be provided with braille signs
to indicate floor level; at each floor, at the door frames
of elevator doors, braille-type signs shall be placed so
that blind persons can be able to discern what
floor the elevator car has stopped and from what level
they are embarking from; for installation heights, see
Section 6.6, Signages;
10.4 Button sizes at elevator control panels shall have
a minimum diameter of 20 mm and should have a
maximum depression depth of 1 mm;
SAFETY

1. FENCING FOR ROADWORKS AND FOOTWORKS

All excavations, whether on the road or footway must
be adequately protected, i.e. fenced. Whatever the
type of fencing used, it is important the railings should
incorporate the following features.
1.1 The height of the top of the rail should be at least
1.00 M. above the adjacent surface.
1.2 The railing should incorporate a tapping rail to
assist the blind, and this should not be greater than
0.35 M. above adjacent surface.
1.3 The fence should be strong enough to offer
resistance should a blind person walk into it.
1.4 Gaps should not occur between adjoining fence
lengths.
2. COVERS FOR EXCAVATIONS
2.1 Excavations in the footway or carriageway where
pedestrians may walk are covered over temporarily
with properly constructed and supported boards to
provide a temporary path for pedestrians.
2.2 If the footway width will be reduced to less than
1.20 because of the excavation, the temporary
covering should extend across the whole of the
footway.
2.3 Minimum dimensions at obstructions
2.3.1 Effective width of footways past any obstruction
should not be less than 1.20 M.
2.3.2 If unavoidable, loose materials temporarily stored
on footways must be properly fenced and prevented
from encroaching onto the main footway by the use of
a kickboard at least 0.20 M. high which will also serve
as a tapping board for the blind.
3. SIGNAGE FOR ROADWORKS ON THE CARRIAGEWAY

3.1 Temporary signs used to warn of roadworks should

be carefully located and should not cause any
inconveniences
to
pedestrians,
particularly
the
disabled.
3.1.1 Signs should be located on verges or similar
whenever these are available.
3.1.2 Signs should not reduce the available footway
width to less than 1.20 M.
4. LOCATION OF EMERGENCY EXIT
4.1 Wall mounted or free standing tablets with an
embossed plan configuration of the building which also
shows the location of the lobby, washrooms and
emergency exits of the building (indicated by different
textures with corresponding meanings) should be
provided either in front of the building or at the main
lobby. The markings of this tablet should be readable
by both the fully sighted and the blind persons.
4.2 Flashing light directional signs indicating the
location(s) of fire exit shall be provided at every change
in
direction
with
sufficient
power
provided
in
accordance with the provisions for emergency lighting

under Section 3.410 of P.D. NO. 1185 (The Fire Code
of the Philippines)
5. AUDIBLE AND VISIBLE ALARM SYSTEM
5.1 Audio-visual alarm systems shall be provided in all
fire sections, as defined under P.D. NO. 1185
otherwise known as The Fire Code of the Philippines,
of buildings in accordance with the guidelines provided
under Section 3.503 of the same.
5.2 For buildings of residential occupancies, i.e.
Groups A and B, as defined under Section 701, of
Chapter 7 of P.D. NO. 1096 otherwise known as the
"The National Building Code of the Philippines", the
provision of "VIBRA-ALARMS" for all occupants who

are
either
deaf
or
hearing-impaired
shall
be
compulsory. Nothing follows.
b. Fire Code of the Philippines (R.A. 9514)
Section 7. Inspections, Safety Measures, Fire Safety,

Constructions, and Protective and/or
Warning Systems. - As may be defined and provided in the
Rules and Regulations, owners, administrators or occupants of
buildings, structures and their premises or facilities and other
responsible persons shall be required to comply with the following,
as may be appropriate:
a. Inspection Requirement - A fire safety inspection shall be
conducted by the Chief, BFP or his duly authorized representative as
prerequisite to the grants of permits and/or licenses by local
governments and other government agencies concerned, for the:
(1) Use or occupancy of buildings, structures, facilities or their
premises including the installation or fire protection and fire safety
equipment, and electrical system in any building structure or facility;
and
(2) Storage, handling and/or use of explosives or of combustible,
flammable, toxic and other hazardous materials;
b. Safety Measures for Hazardous Materials - Fire safety measures
shall be required for the manufacture, storage, handling and/or use
of hazardous materials involving:
(1) cellulose nitrate plastic of any kind;
(2) combustible fibers;
(3) cellular materials such as foam, rubber, sponge rubber and
plastic foam;
(4) flammable and combustible liquids or gases of any classification;
(5) flammable paints, varnishes, stains and organic coatings;
(6) high-piled or widely spread combustible stock;

(7) metallic magnesium in any form;

(8) corrosive
liquids,
oxidizing materials,
organic peroxide,
nitromethane, ammonium nitrate, or any amount of highly toxic,

pyrophoric, hypergolic, or cryogenic materials or poisonous gases as
well as material compounds which when exposed to heat or flame
become a fire conductor, or generate excessive smoke or toxic
gases;
(9) blasting agents, explosives and special industrial explosive
materials, blasting caps, black powder, liquid nitro-glycerine,
dynamite, nitro cellulose, fulminates of any kind, and plastic
explosives containing ammonium salt or chlorate;
(10) fireworks materials of any kind or form;
(11) matches in commercial quantities;
(12) hot ashes, live coals and embers;
(13) mineral, vegetable or animal oils and other derivatives/by
products;
(14) combustible waste materials for recycling or resale;
(15) explosive dusts and vapors; and
(16) agriculture, forest, marine or mineral products which may
undergo spontaneous combustion.
(17) any other substance with potential to cause harm to persons,
property or the environment because of one or more of the following:
a) The chemical properties of the substance; b) The physical
properties of the substance; c) The biological properties of the
substance. Without limiting the definition of hazardous material, all
dangerous goods, combustible liquids and chemicals are hazardous
materials.
c. Safety Measures for Hazardous Operation/Processes - Fire Safety
measures
shall
be
required
for
the
following
hazardous
operation/processes:
(1) welding or soldering;
(2) industrial baking and drying;

(3) waste disposal;

(4) pressurized/forced-draft burning equipment;
(5) smelting and forging;
(6) motion picture projection using electrical arc lamps;
(7) refining, distillation and solvent extraction; and
(8) such other operations or processes as may hereafter be
prescribed in the Rules and
Regulations.
d. Provision on Fire Safety Construction, Protective and Warning
System - Owners, occupants or administrator or buildings, structures
and their premises or facilities, except such other buildings or
structures as may be exempted in the rules and regulations to be
promulgated under Section 5 hereof, shall incorporate and provide
therein fire safety construction, protective and warning system, and
shall develop and implement fire safety programs, to wit:
(1) Fire protection features such as sprinkler systems, hose boxes,
hose reels or standpipe systems and other firefighting equipment;
(2) Fire Alarm systems;
(3) Fire walls to separate adjoining buildings, or warehouses and
storage areas from other occupancies in the same building;
(4) Provisions for confining the fire at its source such as fire resistive
floors and walls extending up to the next floor slab or roof, curtain
boards and other fire containing or stopping components;
(5) Termination of all exits in an area affording safe passage to a
public way or safe dispersal area;
(6) Stairway, vertical shafts, horizontal exits and other means of
egress sealed from smoke and heat;
(7) A fire exit plan for each floor of the building showing the routes
from each other room to appropriate exits, displayed prominently on
the door of such room;
(8) Self-closing fire resistive doors leading to corridors;

(9) Fire dampers in centralized air conditioning ducts;

(10) Roof vents for use by fire fighters; and
(11) Properly marked and lighted exits with provision for emergency
lights to adequately illuminate exit ways in case of power failure.
2. Security Measures
a. Digital Security Measures
i. Video Surveillance
Video surveillance systems are increasingly being
used in security systems and with good reason. Even the
presence of video cameras acts as a deterrent to potential
criminals. Possible dangers are also detected at any early
stage. Appropriate and rapid intervention will enable damage
at least to be contained. Given the ever-growing sources of
danger and increasing losses, video surveillance is an
extremely valuable and economical means of improving the
security of people, buildings and valuables.68
With a video surveillance system, you are always in the
picture - 24 hours a day, 7 days a week. And you dont even
have to sit in front of a TV screen. As soon as an unusual
incident occurs, an appropriate signal is automatically
transmitted to a predetermined location (e.g. to a mobile
phone). Appropriate steps can then be taken immediately to
minimize damage.
The purpose of video surveillance is to discourage
criminals, but if a crime does take place it also makes it
possible to establish the course of events and identify the
people and objects involved. To optimize the use of a video
surveillance system the following criteria should be met:
68
http://www.buildingtechnologies.siemens.com/, Date retrieved: July 20, 2014


There should be two types of cameras: wide-angle

overview cameras and close-up cameras.
The number of wide-angle cameras and their
placement should be sufficient to cover all the points of
interest in the monitored area(s) with good image quality.
There should be close-up cameras whose placement
and type should be such that they can provide detail-rich
images with the right proportions. It is preferable that these
images show both the whole body of the person(s) in the shot,
and closer head-and-shoulders shots as well. Appropriate
places for close-up cameras would be at the cash register and
the entrance, for example.
There should be enough light.
There should be a set schedule and routines for regular
system evaluations.
There should be a documented action plan for what
should be done if there is suspicion of criminal activity.
Staff should be trained to operate the system correctly
and given the opportunity to keep their knowledge up to
date.69
Recordings that show criminal activity must be handled
in such a way that the original images can be handed over to
the justice system in a manner that is in accordance with the
law.
Analogue cameras
The CCD-chip technology used in Siemens analogue
cameras makes it possible to provide high resolution and sharp

color images provided that the light conditions are good
Day-night cameras
All of Siemens day-night cameras build on the latest CCD
chip technology and deliver clear images around the clock. To

take full advantage of the day-night technology we recommend
69
Video Surveillance Portfolio, Siemen, http://www.buildingtechnologies.siemens.com Date retrieved, July 20, 2014

the use of some form of infrared (IR) lighting that switches on

automatically at the same time that the camera switches over to
night mode. The integrated IR filter should also be disabled at this
time.
High-speed varifocal dome cameras

Siemens high-speed dome cameras are available in a
variety of formats: one color model and three day-night models

with exceptional functionality in challenging light conditions.
Mechanical IR filters make it possible for day-night cameras to
produce clear monochrome images. A wide range of mounting
accessories is available, including outdoor, indoor or vandalresistant camera housings70
ii. Pressure Mats

Floor pressure mats or pads are designed to detect a
person treading on them, their primary use is in the security
industry. They offer a low cost covert method of detecting a
person and will provide years of service.
71The
pressure mat/pad
should be mounted on a flat and even floor then covered with a

conventional floor covering such as carpet. Pressure Mats / Pads
were designed to comply with the British standard BS 4737 Part
3: Section 3.9
Many other applications have been found for these floor
pressure mats / pads such as, sensors for interactive toys,
sensors for interactive multimedia systems, i.e. when a person
treads on a floor mat a multimedia presentation is triggered
therefore targeting the presentation accurately.
b. Other Security Measures and Services

Typically, the facilities management department may
perform some of the functions and manage those aspects that
are contracted out. The mix of in-house and outsourced services
70
71
Ibid
http://www.arun-electronics.co.uk, Date retrieved July 21,2014

varies based on the specific needs of each company, whether

union workforces are involved, and whether classified federal
work is being performed. Routine tasks are often outsourced.
i.
Admittance Monitoring and Control

Routine admittance monitoring entails controlling
admittance at the perimeter of the building through a
combination of security guards, concierge services, or
electronics such as the installation of electronic card
access systems. The number of security guards
needed depends on the design and size of the facility
and the area crime rate.
ii.
Visitor Processing
As part of the admittance control process, customers
want the perimeter guard or concierge to call their
offices upon the arrival of guests. In secure areas,
visitors are issued badges and/or escorted to
customers' offices.72
iii.
Alarm Response
An alarm response service is the local process for
monitoring and responding to alarms in the building
and taking action when the response dictates.
Depending on security hardware installed at the site, it
may
involve
monitoring
closed-circuit
television
systems. This task may be quite specialized in some

companies.
iv.
Monitoring Parking
If the property has a parking lot or garage, security may
involve routine periodic checks or patrols of the parking
area,
assisting
customers
with
directions,
and
providing jump starts for their vehicles. These guards
72
Security Measures and Services, http://www.fmlink.com/, Date retrieved, July 20, 2014

also notify the police to respond to events taking place

in these parking areas.
v.
Directing Municipal Emergency Services

When an emergency takes place on the property, the
security personnel are normally assigned to direct the
emergency services to the emergency site. This work
is likely to be outsourced if a company likewise
outsources its entire security program. In other
instances, depending on the nature of the emergency
and local procedures, security personnel remain at the
site to help with crowd control or to act at the direction
of in-house emergency services personnel or the
property manager.73
vi.
Documentation of Conditions and Incidents

The security service observes and documents site
conditions. Routine documentation includes reporting
the presence of hazards, making written reports of
security-related incidentssuch as theft or damage
and notifying facility operations personnel of the
incident. The facility manager and the property
manager should establish a policy to identify who will
be authorized to sign a criminal complaint against
persons who have committed crimes that damage the
property or cause loss of assets. Consultation with the
owner's legal counsel should be made during the policy
formulation process.74
vii.
Maintaining Logs
As part of the audit process, security personnel
normally maintain log books that record entries of
personnel after business hours, equipment failures or
building problems such as water leaks or elevator
breakdowns, and the delivery of packages and other
items on behalf of facility operations personnel.
73
74
Ibid.
Ibid.

viii.
Tracking Incidents
Facility operations should maintain statistics of
incidents taking place on the property to identify trends
and take measures to prevent additional incidents.
Numerous low-cost software programs are available in
the security marketplace to simplify this process.
These programs allow for loading individual reports
into an automated database that can sort incidents by
type, date, severity, and degree of danger.75
ix.
Security for Customer Areas

For reasons of liability in multi-customer buildings,
access to and from the customer areas should be
controlled by the customers, except in instances of an
emergency. If space is leased, the lease document
should define standards for the types of equipment and
devices that the customers may choose to install to
control access. If the lease does not specify
equipment, the facility manager should work with
customers to set standards for the equipment.
Minimum standards should be set regarding locks and
security
minimum
systems.
Customers
standards
when
should
installing
meet
their
the
own
equipment. They should also be given the option to

exceed the standard as long as life-safety codes are
followed. In single-customer facilities, there may be a
need to collaborate with the tenant in devising
approaches to security. The facility manager may
control some aspects of access to the customer areas
through a guard service or electronic devices.
However, the precise nature of the additional service
must be defined in writing to limit the liability of the
company and the facilities management department.
Protection of High Value, Customer Owned Equipment
75
Ibid

Customers
bear
the
primary
responsibility
for
protecting high-value equipment and commodities from

losses because of crime or other events. Facility
operations must collaborate closely with the property
manager to reassure customers who have this
exposure.
x.
Exterior Patrols
The use of exterior security patrols, particularly
motorized ones, should be carefully evaluated. On
properties located in suburban or rural areas with low
crime rates, the deployment of these patrols may be
hard
to
justify.
However,
these
patrols
are
recommended in urban or suburban areas where crime

is commonplace and where adjacent properties have
such patrols. If there are multiple buildings and the
property is large enough to require traveling from one
building to another (a campus setting, for instance),
motorized patrol vehicles are recommended. Strict
guidelines for personnel assigned to motorized patrols
should be written and incorporated into the guardtraining program.76
xi.
Interior Patrols
Historically, guard patrols of the interior of a property
were common because they were often required as a
condition of fire insurance. Modern smoke detection
devices and security electronics, such as access
control and surveillance systems, decrease the need
for interior security patrols. Furthermore, an increasing
number of thefts and other breaches of security each
year are caused by guards. Unless technology cannot
adequately protect the property, interior patrols are not
recommended.
76
Ibid

However, some facilities that insurance carriers

classify as highly protected risks require guard patrols
as a condition of insurance. Typically, these facilities
are special use properties, such as refineries and highhazard manufacturing or production sites, and not
typical
commercial
properties.
Even
in
these
occupancies, more reliable forms of surveillance are

increasingly being used, such as robotic tour devices
(automated cars mounted with video cameras that
transmit live images).
xii.
Exterior Area Emergency Devices

A number of devices are becoming increasingly
popular for protecting personnel in parking garages
and parking lots. These devices, described as
"assistance stations," consist of brightly painted or
marked poles containing two-way intercoms that are
continuously monitored by staff. Remote controls are
also available and are typically purchased by the
customer. These devices contain strobe lights and
CCTV devices that can be activated by a customer or
passerby in the event of an emergency. Facilities in
high crime areas with customer populations that work
evenings should consider installing these devices.77
C. Green Architecture and Other Innovations

1. Concept Tree - Fresh Water
Collector
Designed
for
use
in
tropical desert areas of Africa

and the Americas. Fresh and
drinkable water here can be
safely
called
as
luxury!
Temperatures in those areas

Hope Tree, Photo taken from
http://itechfuture.com
77
Ibid

show erratic swings between day

and night, making it almost
impossible for natives of those
areas to get a steady source of
drinking water. Hope Tree is a
large tree-shaped device that
absorbs moisture from the air to
supply drinking water. The huge
and expansive folded surface of
the Hope Tree grabs moisture or
Hope Tree Section, Photo taken from

water particles from the air,

which trickle down from the
central column and pass through
a series of filters to generate
fresh and drinkable water. This
water is then dispensed through
the easy access base fitted with
taps. Incredibly beautiful idea.
H2O Entry, Photo taken from

While this is just a concept but
should be soon converted into reality for hundreds and thousands of

people who are deprived of some drinking water.
2. The future of street lighting

for solar energy
Surprisingly for a walk in
the
evening
of
beautiful,
fabulously lit trees. The use of

solar energy will make a fairy tale
uTree, Phot taken from http://itechfuture.com/
come true and give energy saving

and environmental preservation
of the industrial city. The uTree
concept is one of the most
realistic
concepts
for
urban
energy generation since these

trees can be installed virtually
anywhere as they do not require
uTree, Photo taken from http://itechfuture.com

more than a few inches of floor

space for the supporting pole and
take up a few square feet of
overhead space.
A
rotation
engine
optimizes energy production by
LED Lights used in uTree, Photo taken from

itechfuture.com
ensuring that the leaves are

always facing the sun at the
correct
angle
screwed
while
easy
connections
allow
each uTree to be easily set up

and dissembled. There are 77
cells
per
leaf
and
each
generates over 2.5w energy per
PV Leaves, Photo taken from itechfuture.com
day. Each tree can generate over 1732.5W in an 8 hour day, which
equals 13.86 KWH/day per uTree, or 5058 KWH per tree per year. This
kind of energy would be sufficient to feed 20 street lights every night.
You agree that this is interesting and it should be used! Designer Xabier
Perez de Arenaza78
3. Solar Windows
Solar windows look like
conventional windows but they
are coated in a transparent dye.
The dye captures, concentrates
and redirects light along the
surface
of
the
glass
to
photovoltaic cells in the frame.
Solar Window, Photo taken from

http://www.greeninnovation.co.uk
These photovoltaic cells convert the light into electricity.

Photo voltaic cell that have been incorporated into this system
generate approximately ten times the amount of energy than if they
would stood alone. Potentially solar windows will not be particularly
78
Ibid

expensive to produce as glass.

Much of the technology is already
in place with glass routinely
coated.79
4. Composting
Kitchen waste (left over food, for
example) produces methane - a
particularly
potent
greenhouse
Composting, Photo taken from

http://www.greeninnovation.co.uk
gas. Composting exposes these

materials to oxygen, preventing
the release of methane, and
producing a useful, nutrient rich
by-product, which can be added
to your beds. Most councils now
supply composting bins, or better
still, invest in a wormer. A
compost
heap
can
built
for
relatively l ittle expense.80
Solar Heater, Photo taken from

www.geinnovations.net
5. Solar Water Heating System

The fossil and other fuel resources are finite, that is why the
world has started curtailing conventional methods for heating water and
have switched over to solar water heating systems.
To start with, they are inexpensive in the long run, safe, reliable,
and are easy to maintain. More importantly, they are eco-friendly and
the energy source used is renewable81
79
Green Innovation, http://www.greeninnovation.co.uk/, Date retrieved: July 27, 2014

Ibid.
81 Solar Heater, www.geinnovations.net, Date retrieved: July 28,2014
80

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H.I.V.E.

The Homecare Facility

for the suffering soul, world is healing.1

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Long-Term Care Home Design Manual, Ministry of Health and

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WHO-AIMS Report on Mental Health System in the Philippines,

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Philippines mental health country profile, Bernardo Conde,

Health Service Delivery Profile, WHO and Department of Health,

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Sikolohiyang Pilipino (Filipino psychology): A legacy of Virgilio

experiences of the people from the indigenous culture. It is based on

Causes of Mental Disorder, Philippines Psychiatric Association,

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